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EXAM: CT Chest wo contrast CLINICAL INFORMATION: Surveillance, axillary artery stenosis COMPARISON: Chest radiograph 10/22/2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 400 mm. DLP: 285.83 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis. Tiny peripheral nodule in the left lower lobe measuring about 0.3 cm (series 2; image 83). HEART / VESSELS: Mild coronary artery calcifications. Aortic valve calcifications without significant dilation of the ascending aorta. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. Circumferential thickening of the distal esophagus may reflect reflux esophagitis. LYMPH NODES: Borderline enlarged mediastinal lymph nodes measuring up to 1.0 cm in short axis. CHEST WALL: A vascular graft is seen extending from the right subclavian artery along the right anterolateral chest wall. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Anterior wedge compression deformity of the T12 vertebral body, likely chronic. CONCLUSION: 1. A surgical graft is seen extending from the right subclavian/axillary artery. The artery is not well evaluated on this noncontrast examination. 2. Nonspecific borderline enlarged mediastinal lymph nodes. 3. Incidental findings of small hiatal hernia, probable reflux esophagitis, mild coronary artery calcifications, mild likely chronic anterior wedging of the T12 vertebral body.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral dependent atelectasis. Tiny peripheral nodule in the left lower lobe measuring about 0.3 cm (series 2; image 83). HEART / VESSELS: Mild coronary artery calcifications. Aortic valve calcifications without significant dilation of the ascending aorta. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. Circumferential thickening of the distal esophagus may reflect reflux esophagitis. LYMPH NODES: Borderline enlarged mediastinal lymph nodes measuring up to 1.0 cm in short axis. CHEST WALL: A vascular graft is seen extending from the right subclavian artery along the right anterolateral chest wall. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Anterior wedge compression deformity of the T12 vertebral body, likely chronic.
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Findings: There is no reduction of CBV or CBF. No Tmax prolongation greater than 4 seconds is seen. There is 52 mL of Tmax greater than 4 seconds. Seen on parametric maps diffusely in both cerebral hemispheres, possibly artifactual. ---------------
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2,701
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Right-sided abdominal pain. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 165 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80 sec Scan field of view: 429 mm. DLP: 559.30 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gas-filled loops of small bowel are seen within the upper abdomen without convincing evidence of obstruction. No wall thickening. COLON / APPENDIX: Visualized portions of the appendix and colon are unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Thick-walled. REPRODUCTIVE ORGANS: Prostatomegaly BODY WALL: No significant abnormality. MUSCULOSKELETAL: A lucent lesion within the left femoral head is likely degenerative. No focal destructive osseous lesion is identified. CONCLUSION: 1. No definite acute abnormality is identified within the abdomen or pelvis. 2. Thick-walled urinary bladder is thought probably related to chronic outlet obstruction given prostatomegaly. Correlation with urinalysis recommended to exclude UTI/cystitis. 3. Additional findings above.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Gas-filled loops of small bowel are seen within the upper abdomen without convincing evidence of obstruction. No wall thickening. COLON / APPENDIX: Visualized portions of the appendix and colon are unremarkable. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Thick-walled. REPRODUCTIVE ORGANS: Prostatomegaly BODY WALL: No significant abnormality. MUSCULOSKELETAL: A lucent lesion within the left femoral head is likely degenerative. No focal destructive osseous lesion is identified.
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Findings: Lines and Tubes: None. Body Wall and Abdomen: No destructive osseous lesions. CT of abdomen and pelvis will be reported separately. Lymph Nodes, Mediastinum and Neck: No axillary or mediastinal adenopathy. Lungs and Pleura: New small right pleural effusion. Index nodules are measured on series 201: 1. Spiculated left upper lobe nodule measures 2.7 x 2.1 cm image 81, previously 2.8 x 2.3 cm. 2. Nodule adjacent to the left inferior pulmonary vein and aorta measures approximately 2.7 x 2.8 cm image 142, previously 3.6 x 3.2 cm. Most other pulmonary nodules show moderate enlargement, for instance a subpleural right upper lobe nodule which has increased in size from 1.2 x 1.3 cm to approximately 2.5 x 2.2 cm, currently image 61. Interlobular septal thickening in the right hemithorax suggestive of lymphangitic carcinomatosis, also present on previous. Cardiovascular: No large pericardial effusion. Heart size is normal. Low-density blood pool.
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2,702
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EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 75-year-old male with provided history of chest pain. COMPARISON: Chest CT 9/3/2021 TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 325 mm. DLP: 129.10 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory technique in supine position. FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Redemonstrated subpleural reticulations with subpleural sparing mainly involving the right upper and right lower lung lobes. There is interval improvement of subpleural opacities in the left side. This is associated mild bibasilar traction bronchiolectasis and groundglass opacities. No honeycombing. Inferior lingular subsegmental atelectasis with mild bronchiectatic changes, similar to prior. No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: Mildly enlarged and subcentimeter mediastinal lymph nodes are noted. The esophagus is nondilated. Aortic valve replacement by by prosthesis. The thoracic aorta is normal in caliber with extensive atherosclerotic calcifications. Main pulmonary artery is normal in caliber. Status post CABG. The overall heart size normal. No pericardial effusion. Bones and soft tissues: Median sternotomy with intact sternotomy wires. No aggressive bone lesion. Chest wall soft tissues are unremarkable. Upper abdomen: Unremarkable for the technique. CONCLUSION: 1. Redemonstrated subpleural reticulations with subpleural sparing mainly involving the right upper and right lower lobes. There is interval improvement of subpleural opacities in the left side. This is associated mild traction bronchiolectasis without honeycombing. Changing likely related to mild interstitial lung disease (NSIP pattern) or may be aspiration related. 2. Other findings as described.
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FINDINGS: Limitations: None. Chest: Lines, tubes, and devices: None. Lung parenchyma and pleura: Redemonstrated subpleural reticulations with subpleural sparing mainly involving the right upper and right lower lung lobes. There is interval improvement of subpleural opacities in the left side. This is associated mild bibasilar traction bronchiolectasis and groundglass opacities. No honeycombing. Inferior lingular subsegmental atelectasis with mild bronchiectatic changes, similar to prior. No focal consolidation. The trachea and main bronchi are patent. No pleural effusion. Thoracic inlet, heart, and mediastinum: Mildly enlarged and subcentimeter mediastinal lymph nodes are noted. The esophagus is nondilated. Aortic valve replacement by by prosthesis. The thoracic aorta is normal in caliber with extensive atherosclerotic calcifications. Main pulmonary artery is normal in caliber. Status post CABG. The overall heart size normal. No pericardial effusion. Bones and soft tissues: Median sternotomy with intact sternotomy wires. No aggressive bone lesion. Chest wall soft tissues are unremarkable. Upper abdomen: Unremarkable for the technique.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Suspected hypoattenuating lesions throughout the liver, not well evaluated due to noncontrast technique (for example, series 201, images 206, 215, 245). BILIARY TRACT: Normal. GALLBLADDER: Absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal for technique. No hydronephrosis bilaterally. LYMPH NODES: Retroperitoneal lymphadenopathy is visualized (series 201, image 263). Direct comparison to prior PET/CT is somewhat limited, but this appears slightly worsened. The largest node measures approximately 2.8 x 1.7 cm (series 201, image 251). STOMACH / SMALL BOWEL: Postsurgical changes are seen within the small bowel. The stomach appears overall normal. Right lower quadrant ileal conduit is noted. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. Otherwise, the colon, including the appendix, is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic disease of the abdominal aorta which is normal in caliber. URINARY BLADDER: Surgically absent. REPRODUCTIVE ORGANS: Surgically absent. BODY WALL: Right lower quadrant ileostomy. Small nodule within the left inguinal canal appears to be a trace amount of fluid (series 201, image 469). MUSCULOSKELETAL: Sclerosis of the L2 and L3 vertebral bodies are noted, worsened compared to 4/2021. Comparison to more recent prior PET is limited due to inability to window examination. Suspected L2 superior endplate fracture (series 203, image 166), without compression deformity.
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2,703
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 51-year-old woman with history of right flank myxofibrosarcoma COMPARISON: 6/24/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 215 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 88 sec. Scan field of view: 457 mm. DLP: 1029 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT performed today will be reported separately. ABDOMEN and PELVIS: LIVER: Mild steatosis appears unchanged. No focal lesions are evident. BILIARY TRACT: Normal. GALLBLADDER: Heterogeneity within the distended gallbladder lumen is compatible with numerous noncalcified stones. No pericholecystic fluid or focal wall thickening are identified. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality aside from a short portion of the ileum being located in the right flank hernia, without obstruction. COLON / APPENDIX: No abnormality aside from the right: The located in the flank hernia without obstruction. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Several small uterine fibroids appear unchanged. No new abnormalities. BODY WALL: The right posterolateral lower abdominal wall low-attenuation lesion abutting the right iliac crest appears similar to the most recent study, with the overall cystic appearing component plus surrounding soft tissue stranding measuring 6.4 x 5.3 cm (image 232 series 302) today; was 6.5 x 5.4 cm (image 207 series 2) on the most recent CT. The irregular enhancing margin of the cystic appearing component is more pronounced today, and there is sclerosis and cortical irregularity of the adjacent iliac bone that is likely due to postradiation change. The previously noted right abdominal wall laxity located superior to the incision once again contains fat as well as the ascending colon and distal ileal loops without obstruction. Small supraumbilical fat-containing hernias and smaller fat-containing umbilical hernia appear unchanged. Moderate soft tissue stranding in the midline back and thickening along the right flank incision are stable. MUSCULOSKELETAL: Bilateral sacroiliac and diffuse lumbar facet degenerative change. Post radiation sclerosis is present in the superior aspect of the right iliac wing. CONCLUSION: 1. Stable size of recurrent myxofibrosarcoma involving the lower right flank, though the rim of the cystic appearing component appears more enhancing on today's scan; this is likely due to later acquisition/contrast timing. 2. No evidence of distant metastatic disease. 3. Right flank hernia appears similar to prior. 4. Cholelithiasis and other incidental findings as above, stable.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT performed today will be reported separately. ABDOMEN and PELVIS: LIVER: Mild steatosis appears unchanged. No focal lesions are evident. BILIARY TRACT: Normal. GALLBLADDER: Heterogeneity within the distended gallbladder lumen is compatible with numerous noncalcified stones. No pericholecystic fluid or focal wall thickening are identified. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality aside from a short portion of the ileum being located in the right flank hernia, without obstruction. COLON / APPENDIX: No abnormality aside from the right: The located in the flank hernia without obstruction. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Several small uterine fibroids appear unchanged. No new abnormalities. BODY WALL: The right posterolateral lower abdominal wall low-attenuation lesion abutting the right iliac crest appears similar to the most recent study, with the overall cystic appearing component plus surrounding soft tissue stranding measuring 6.4 x 5.3 cm (image 232 series 302) today; was 6.5 x 5.4 cm (image 207 series 2) on the most recent CT. The irregular enhancing margin of the cystic appearing component is more pronounced today, and there is sclerosis and cortical irregularity of the adjacent iliac bone that is likely due to postradiation change. The previously noted right abdominal wall laxity located superior to the incision once again contains fat as well as the ascending colon and distal ileal loops without obstruction. Small supraumbilical fat-containing hernias and smaller fat-containing umbilical hernia appear unchanged. Moderate soft tissue stranding in the midline back and thickening along the right flank incision are stable. MUSCULOSKELETAL: Bilateral sacroiliac and diffuse lumbar facet degenerative change. Post radiation sclerosis is present in the superior aspect of the right iliac wing.
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FINDINGS: ONCOLOGIC FINDINGS: INDEX LESION(S): Measured on series 202 1. Mixed attenuating metastasis in the midline pelvis just cranial to the bladder measures 6.4 x 4.7 cm on image 438, previously 8.9 x 7.3 cm. Increasing central hypoattenuation suggesting increasing necrosis. 2. Mixed cystic and solid metastasis along the left external iliac chain measures 5.8 x 4.3 cm on image 374, previously 4.5 x 3.3 cm, with an increasing cystic component. 3. Heterogeneously attenuating metastasis in the left paracolic gutter measures 4.3 x 3.4 cm on image 353, previously 4.2 x 3.1 cm. NEW SITES OF DISEASE: None. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated CT chest. ABDOMEN and PELVIS: LIVER: Unchanged tiny focus of hypoattenuation in the posterior segment right hepatic lobe on image 18 series 202, statistically a cyst. No new liver lesions. BILIARY TRACT: Mild intrahepatic and extrahepatic ductal dilation is similar to prior. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter foci of hypoattenuation in the right kidney are too small for accurate characterization. Similar peripherally located calcified right renal artery aneurysm. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Post surgical changes from partial colectomy with anastomotic suture in the left hemipelvis. Appendix is not seen. PERITONEUM / MESENTERY: Increased size of the majority of the peritoneal metastases compared to the prior exam. The largest mass centered in the midline pelvis has decreased in size. No ascites. RETROPERITONEUM: Normal. VESSELS: Scattered atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Multiple metastases are present immediately adjacent to the bladder dome. REPRODUCTIVE ORGANS: Uterus and ovaries are absent. BODY WALL: Metastasis in the right lower paramedian abdominal wall has decreased in size. MUSCULOSKELETAL: Osteopenia. No destructive osseous lesions seen.
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2,704
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EXAM: CT Chest with contrast CLINICAL INFORMATION: 51-year-old female with recurrent right flank myxofibrosarcoma. COMPARISON: FDG PET/CT dated 8/20/2021, CT chest with contrast dated 2/20/2021.. TECHNIQUE: CT Chest with contrast. Patient weight: 215 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 35 sec. Scan field of view: 352 mm. DLP: 284 mGy cm. FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No suspicious pulmonary nodule. No pleural effusion. HEART / VESSELS: No pericardial effusion. No central PE. MEDIASTINUM / ESOPHAGUS: Mild esophageal wall thickening, without focal abnormality. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No destructive osseous lesion. CONCLUSION: 1. No evidence of intrathoracic metastasis. 2. Mild esophageal wall thickening, could be related to esophagitis.
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FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. No suspicious pulmonary nodule. No pleural effusion. HEART / VESSELS: No pericardial effusion. No central PE. MEDIASTINUM / ESOPHAGUS: Mild esophageal wall thickening, without focal abnormality. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No destructive osseous lesion.
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Findings: Lines and Tubes: Right-sided port tip terminates in the upper right atrium, similar. Body Wall and Abdomen: No destructive osseous lesions. CT of abdomen and pelvis will be reported separately. Lymph Nodes, Mediastinum and Neck: No axillary or mediastinal adenopathy. A few small mediastinal lymph nodes have a similar appearance. Lungs and Pleura: No pleural effusion. Several tiny nodules are present in the lower portion of the right upper lobe and in the middle lobe. Small middle lobe nodule image 178 series 202 is similar. A few airway secretions in the lingula have a similar appearance. Small left lower lobe nodule near a bronchial bifurcation image 158 may represent a small lymph node and is unchanged. Cardiovascular: No central PTE. Heart size is at the upper limits of normal. No large pericardial effusion.
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2,705
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 75-year-old male with squamous cell carcinoma of the penis; follow-up. COMPARISON: CT abdomen pelvis 9/24/2020 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 186 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80 sec Scan field of view: 356 mm. DLP: 841 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Well-circumscribed hypodensity in the right hepatic lobe segment 5, most suggestive of a cyst (axial series 201, image 238. Additional ill-defined subcentimeter hypoattenuating lesion noted on axial series 201, image 216. BILIARY TRACT: Normal. GALLBLADDER: Hyperdensity seen near the fundus of the gallbladder, perhaps representing small stones or sludge. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Simple left renal cyst. Nonspecific bilateral perinephric stranding. LYMPH NODES: Markedly enlarged, morphologically abnormal left inguinal lymph node measures approximately 8.1 x 6.8 cm on axial series 201, image 506 (previously 3.0 x 2.2 cm). Additional mildly prominent left external iliac lymph node measures 1.2 cm in short axis on axial series 201 166 (previously 1.0 cm in short axis). Mildly prominent bilateral obturator lymph nodes. No enlarged or morphologically abnormal retroperitoneal lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Sigmoid colonic anastomotic suture line noted. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Moderate to advanced atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Heterogeneous enhancement and abnormal stranding involving the base of the penis as seen on axial series 201, image 528. Prostate is mildly enlarged. BODY WALL: Tiny fat-containing periumbilical hernia. Evidence of prior lower midline laparotomy. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Heterogeneously enhancing lesion involving the base of the penis with marked interval increase in size of an abnormal left inguinal lymph node. Adjacent mildly prominent left external iliac chain lymph node is nonspecific. 2. Ill-defined subcentimeter hypodensity seen within the right hepatic lobe. Although perhaps representing a benign lesion such as a cyst, this is indeterminate on a single phase study and in the setting of underlying malignancy. Consider further evaluation with liver MRI with Eovist. 3. Hyperdensity within the gallbladder fundus, likely small stones or sludge.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Well-circumscribed hypodensity in the right hepatic lobe segment 5, most suggestive of a cyst (axial series 201, image 238. Additional ill-defined subcentimeter hypoattenuating lesion noted on axial series 201, image 216. BILIARY TRACT: Normal. GALLBLADDER: Hyperdensity seen near the fundus of the gallbladder, perhaps representing small stones or sludge. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Simple left renal cyst. Nonspecific bilateral perinephric stranding. LYMPH NODES: Markedly enlarged, morphologically abnormal left inguinal lymph node measures approximately 8.1 x 6.8 cm on axial series 201, image 506 (previously 3.0 x 2.2 cm). Additional mildly prominent left external iliac lymph node measures 1.2 cm in short axis on axial series 201 166 (previously 1.0 cm in short axis). Mildly prominent bilateral obturator lymph nodes. No enlarged or morphologically abnormal retroperitoneal lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Sigmoid colonic anastomotic suture line noted. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Moderate to advanced atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Heterogeneous enhancement and abnormal stranding involving the base of the penis as seen on axial series 201, image 528. Prostate is mildly enlarged. BODY WALL: Tiny fat-containing periumbilical hernia. Evidence of prior lower midline laparotomy. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: AORTIC MEASUREMENTS: AORTIC ROOT AT THE SINUSES: 3.6 x 3.8 x 4.2 cm. MID-ASCENDING THORACIC AORTA: 4.0 x 3.7 cm. AORTIC ARCH: 3.6 x 3.2 cm. PROXIMAL DESCENDING THORACIC AORTA: 3.8 x 3.5 cm. MID DESCENDING THORACIC AORTA: 4.9 x 4.4 cm (previously 5.3 x 4.4 cm although suboptimal measurement). DISTAL DESCENDING THORACIC AORTA: 3.7 x 3.4 cm. STRUCTURED REPORT: CTA Chest VASCULATURE: No evidence of dissection. CORONARY ARTERIES: There are moderate atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: Normal size. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: A saccular bilobed aortic outpouching has increased in craniocaudad dimensions now spanning 3.6 cm (previously 0.9 cm). Dense intramural hematoma along the posterior lateral aspect of the descending thoracic aorta has decreased. UPPER ABDOMINAL AORTA: See separate abdominal dictation. ------------------------------------------------------------- LOWER NECK: Subcentimeter hypodense thyroid nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Severe paraseptal emphysematous changes with diffuse bronchial wall thickening and minimal fibrotic changes at the lung bases. No effusions. Minimal basilar atelectasis. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Resolved mediastinal hematoma. LYMPH NODES: Stable enlarged mediastinal lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: See separate abdominal dictation. MUSCULOSKELETAL: Similar appearance of a T7 compression deformity.
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2,706
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CT Chest with contrast Clinical Information: 75-year-old male penile SCC, eval for mets Comparison: None Technique: Following injection of non-ionic contrast 2.5 mm images were obtained through the chest. Abdominal findings will be reported separately. Patient weight: 186 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 80 sec Scan field of view: 356 mm. Findings: Small calcified left mediastinal and left hilar nodes are seen. No enlarged intrathoracic nodes are present. Small hiatal hernia is noted. Calcific atherosclerosis is seen in the aorta and coronary arteries with a stent present in the LAD. The heart size and mediastinum are otherwise normal. Small area of patchy opacity is seen in the medial left lower lobe just adjacent to the ascending aorta suggesting either a small area of infection or tiny area of fibrosis. Calcified granuloma are noted in the left lung. Tiny subpleural LUL nodule is seen on series 201 image 60. Tiny central RUL nodule is present on image 83. The 5 x 6 mm RML noncalcified nodule is present on image 133. A 4 x 5 mm noncalcified nodule is present in the RLL on image 162. A tiny nodule is also seen in the superior segment RUL on image 106. A few tiny fissural nodules are noted consistent with benign intrapulmonary lymph nodes. Slight dependent atelectasis is also present. The lungs are otherwise normal. No pleural effusion. An oval lesion is seen in the patient's upper right back which measures fluid density. Overall size is 31 x 59 mm on series 201 image 36 [56 mm craniocaudal on coronal image 228. This is most consistent with a large sebaceous cyst. Small amount of bilateral gynecomastia is seen. No focal destructive osseous lesions identified. CT abdomen and pelvis will be reported separately. Impression: 1.. Previous granulomatous disease. Bilateral small nodules are present with the largest measuring 5 x 6 mm in the RML. These may reflect granulomatous disease but cannot exclude metastasis. Attention on follow-up needed. 2. Focal area of parenchymal density adjacent to the descending aorta and the LLL is consistent with either focal fibrosis or small area of infection/inflammation. 3. Hyperinflation consistent with a large sebaceous cyst. Additional incidental findings as above.
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Findings: Small calcified left mediastinal and left hilar nodes are seen. No enlarged intrathoracic nodes are present. Small hiatal hernia is noted. Calcific atherosclerosis is seen in the aorta and coronary arteries with a stent present in the LAD. The heart size and mediastinum are otherwise normal. Small area of patchy opacity is seen in the medial left lower lobe just adjacent to the ascending aorta suggesting either a small area of infection or tiny area of fibrosis. Calcified granuloma are noted in the left lung. Tiny subpleural LUL nodule is seen on series 201 image 60. Tiny central RUL nodule is present on image 83. The 5 x 6 mm RML noncalcified nodule is present on image 133. A 4 x 5 mm noncalcified nodule is present in the RLL on image 162. A tiny nodule is also seen in the superior segment RUL on image 106. A few tiny fissural nodules are noted consistent with benign intrapulmonary lymph nodes. Slight dependent atelectasis is also present. The lungs are otherwise normal. No pleural effusion. An oval lesion is seen in the patient's upper right back which measures fluid density. Overall size is 31 x 59 mm on series 201 image 36 [56 mm craniocaudal on coronal image 228. This is most consistent with a large sebaceous cyst. Small amount of bilateral gynecomastia is seen. No focal destructive osseous lesions identified. CT abdomen and pelvis will be reported separately.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: Moderate to severe atherosclerotic disease ABDOMINAL AORTA: Dilated abdominal aorta, with several fusiform aneurysms, some with ulceration. The superior portion measures at least 4.8 cm transverse by 3.9 cm AP on image 530 series 501, previously 5.0 cm AP by 3.7 cm transverse on image 194 series 6, similar to prior. The more distal abdominal aortic aneurysm measures approximately 5.5 cm AP by 5.8 cm transverse on image 867 series 501, previously 5.4 AP by 5.5 cm transverse on image 305 series 6, possibly slightly increased from prior. CELIAC AXIS: Marked narrowing at the origin of the celiac artery with poststenotic dilatation, narrowing and then additional poststenotic dilatation is again seen. Proximal common hepatic artery aneurysm is similar to prior, 1.0 cm on image 584 series 501, previously 0.9 cm on series 6 image 210. SMA: Mural thickening previously seen not well seen on today's study. RIGHT RENAL: Mild narrowing of the proximal right renal artery is similar to prior. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: Severe narrowing of the right internal and external iliac arteries (at the bifurcation) is stable from prior. Aneurysmal dilatation of the common iliac artery measures up to 2.9 cm on image 922 series 501, previously 2.9 cm on image 483 series 7, stable from prior. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Mild to moderate narrowing in the common iliac artery. ------------------------------------------------------------- ABDOMEN and PELVIS: LIVER: Subcentimeter hypodensities are statistically cysts. Mildly enlarged at 16.7 cm. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Hyperenhancing left mid renal lesion, not exophytic, measures 1.6 cm on image 676 series 501. High attenuation partially exophytic lesion left mid kidney again seen, indeterminate on these images. Several large probable simple cysts bilaterally. Complex right renal lesion right mid kidney on image 586 series 501 measures 2.2 cm, with possible enhancing septation on the later arterial phase on the prior study. Subcentimeter lesions are statistically cysts but formally indeterminate. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate is mildly enlarged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive osseous lesions seen
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2,707
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 59-year-old female with suspected bowel obstruction. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 129 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 80 sec. Scan field of view: 360 mm. DLP: 430.94 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Indeterminant, noncalcified 6 cm pulmonary nodule in the left lower lobe on axial series 2, image 14. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. Marked dilation of the small bowel with possible transition point in the left lower central abdomen on axial series 2, image 213. The small bowel wall appears normal in thickness and enhancement. COLON / APPENDIX: Mildly prominent air and fluid-filled cecum and ascending colon with relative collapse of the distal colon. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Mild to moderate atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Markedly dilated small bowel with suspected transition point in the left lower mesentery, concerning for bowel obstruction. Presence of air and fluid within the proximal colon distal to the possible transition point would suggest only a partial obstruction. Findings may also be related to pseudoobstruction associated with the patient's underlying history of CREST. Correlation with any prior available cross-sectional imaging of the abdomen and pelvis may be of benefit. 2. Indeterminant left lower lobe pulmonary nodule. Recommend follow-up per Fleischner guidelines. The findings were discussed with Dr. Page Axley by Dr. David Summerlin via telephone on 1/6/2022 2:25 PM.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Indeterminant, noncalcified 6 cm pulmonary nodule in the left lower lobe on axial series 2, image 14. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. Marked dilation of the small bowel with possible transition point in the left lower central abdomen on axial series 2, image 213. The small bowel wall appears normal in thickness and enhancement. COLON / APPENDIX: Mildly prominent air and fluid-filled cecum and ascending colon with relative collapse of the distal colon. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Mild to moderate atherosclerotic disease. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis Renal Donor RIGHT KIDNEY: - RENAL ARTERY: Single. - RENAL VEIN: Duplicated. - COLLECTING SYSTEM: Single. - RENAL CALCULI: Absent. - CYSTS/MASSES: Absent. - VOLUME: 118 cm\S\3 LEFT KIDNEY: - RENAL ARTERY: Single. - RENAL VEIN: Single with conventional pre-aortic anatomy. - COLLECTING SYSTEM: Single. - RENAL CALCULI: Absent. - CYSTS/MASSES: Absent. - VOLUME: 127 cm\S\3 ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Small amount of simple pelvic free fluid. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing periumbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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2,708
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EXAM: CT Abdomen wo+w contrast CLINICAL INFORMATION: 51-year-old male undergoing liver transplant evaluation. COMPARISON: None. TECHNIQUE: CT Abdomen wo+w contrast. Patient weight: 220 lbs. IV contrast: Omnipaque 350, 180 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.20 ml per sec. Scan delay: BOLUS TRACK, 96 SEC., 180 SEC. sec. Scan field of view: 500 mm. DLP: 2507.80 mGy cm. FINDINGS: STRUCTURED REPORT: CT HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Moderate sized right pleural effusion. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. Peripheral wedge-shaped area of arterial enhancement noted in hepatic segment IVb, likely perfusional. Calcified granuloma near the hepatic dome. LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) 2 - Size: 6 mm - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 0 - Enhancing "capsule": Not present. - Nonperipheral "washout": Not present. - Threshold growth (>= 50% in = 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-3 LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Accessory right hepatic artery arises from the SMA. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Multiple stones within the gallbladder which otherwise is normal in appearance. LYMPH NODES: Mildly prominent periportal lymph nodes. SPLEEN: Mildly enlarged. PERITONEUM / ASCITES: Interval resolution of previously noted ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Mild nonspecific stranding. OTHER VESSELS: No significant abnormality. BODY WALL: Small to moderate-sized fat-containing periumbilical hernia. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Cirrhosis with couple of small LR 3 arterially enhancing lesions without corresponding abnormality on venous or delayed phase. No other suspicious hepatic lesion. 2. Cholelithiasis without evidence of acute cholecystitis. 3. Splenomegaly with interval resolution of previously observed ascites. 4. Moderate right pleural effusion, new since the prior study.
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FINDINGS: STRUCTURED REPORT: CT HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Moderate sized right pleural effusion. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. Peripheral wedge-shaped area of arterial enhancement noted in hepatic segment IVb, likely perfusional. Calcified granuloma near the hepatic dome. LIVER LESIONS: - Lesion Number: 1 - Location: Segment(s) 2 - Size: 6 mm - Enhancement: Nonrim arterial phase hyperenhancement - Vascular invasion: No - Additional major features present: 0 - Enhancing "capsule": Not present. - Nonperipheral "washout": Not present. - Threshold growth (>= 50% in = 50% in <= 6 months): Not present. - Other features: None. - LI-RADS: LR-3 LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Accessory right hepatic artery arises from the SMA. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: Multiple stones within the gallbladder which otherwise is normal in appearance. LYMPH NODES: Mildly prominent periportal lymph nodes. SPLEEN: Mildly enlarged. PERITONEUM / ASCITES: Interval resolution of previously noted ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Mild nonspecific stranding. OTHER VESSELS: No significant abnormality. BODY WALL: Small to moderate-sized fat-containing periumbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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Findings: There is a large amount of fluid distending the right iliac is bursa in the lower pelvis. The fluid extends distally through the iliopsoas bursa to the lesser trochanter insertion. It does appear to contact the anterior margin of the right femoral head and neck hardware. No gas is seen within the fluid. Femoral hardware shows no evidence of abnormal motion. There is no aggressive bone destruction.
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2,709
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EXAM: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 246 mm. DLP: 1470.80 mGy cm. (accession CT220003232), Scan field of view: 220 mm. DLP: 1243.20 mGy cm. (accession CT220003238), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. DLP: 962.30 mGy cm. (accession CT220003233), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 247 mm. DLP: 1062.30 mGy cm. (accession CT220003239), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. (accession CT220003234) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: The optic nerve sheaths are slightly large bilaterally but have no significant tortuosity. The ocular globes, muscle and lateral glands are unremarkable. The sella and suprasellar cisterns are not well shown. --------------
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2,710
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EXAM: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 246 mm. DLP: 1470.80 mGy cm. (accession CT220003232), Scan field of view: 220 mm. DLP: 1243.20 mGy cm. (accession CT220003238), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. DLP: 962.30 mGy cm. (accession CT220003233), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 247 mm. DLP: 1062.30 mGy cm. (accession CT220003239), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. (accession CT220003234) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: Comparison: No prior Lungs and Pleura: Patchy and confluent groundglass opacities are present with slight cranial predominance. Located centrally on the right and more peripherally on the left, these are associated with mild bronchiectasis. There were a few patchy groundglass opacities without bronchiectasis on the abdominal CT 3/14/2018. Expiratory images demonstrate no marked air trapping. No pleural effusion. There are no curvilinear subpleural parenchymal bands. No honeycombing. There are a few nodules present which may represent lymph nodes along fissures. Along the right major fissure, one of these measures 11 x 9 mm image 76 series 201, previously approximately 11 x 9 mm on the abdominal CT 3/14/2018. Another more central nodule along the right major fissure measures 5 mm short axis, also similar. A left major fissural nodule measures 8 mm short axis, as on the previous. Lymph Nodes, Mediastinum and Neck: No axillary or mediastinal adenopathy. A few small cardiophrenic lymph nodes are present, similar compared to abdominal CT 3/14/2018. Cardiovascular: Heart size is normal. Main pulmonary artery is at the upper limits of normal for size for patient this age. No pericardial effusion. No dense coronary artery atherosclerotic calcifications. Body Wall and Abdomen: No destructive osseous lesions. Included portions of the upper abdomen show biliary ductal dilatation, as on recent abdominal CT.
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2,711
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EXAM: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 246 mm. DLP: 1470.80 mGy cm. (accession CT220003232), Scan field of view: 220 mm. DLP: 1243.20 mGy cm. (accession CT220003238), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. DLP: 962.30 mGy cm. (accession CT220003233), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 247 mm. DLP: 1062.30 mGy cm. (accession CT220003239), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. (accession CT220003234) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Peripherally calcified lesion within the peripheral aspect of the right hepatic lobe measures 4.0 x 2.8 cm (series 3, image 193), previously 4.2 x 2.9 cm. The more superior smaller hypoattenuating lesion in the right hepatic lobe measures 1.0 x 0.9 cm (series 3, image 172), unchanged. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. The gallbladder is mostly collapsed. However, no wall thickening or pericholecystic fluid is visualized. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged significant left hydronephrosis. There are atrophic changes throughout the left kidney with numerous subcentimeter hypoattenuating lesions, unchanged. Redemonstration of urinary diversion which is similar to prior. LYMPH NODES: Stable retroperitoneal node measures 0.9 x 0.8 cm (series 3, image 224). No new abdominopelvic lymphadenopathy is visualized. STOMACH / SMALL BOWEL: The stomach is normal. Postsurgical changes are seen within the small bowel. COLON / APPENDIX: Postsurgical changes are noted in the sigmoid colon. PERITONEUM / MESENTERY: Numerous peritoneal nodules as detailed below: Hypodense peritoneal mass in the upper right ventral abdomen measures 4.6 x 2.5 cm (series 3, image 242), previously 3.6 x 1.9 cm. Adjacent subcentimeter nodules are redemonstrated, similar to prior. Partially peripherally calcified peritoneal lesion in the right measures 3.0 x 2.4 cm (series 3, image 262), previously 2.6 x 2.0 cm. Left lower quadrant peritoneal lesion which is partially peripherally calcified measures 5.4 x 4.2 cm (series 3, image 293), previously 3.4 x 2.5 cm. The hypodense lesion within the presacral region measures 5.3 x 4.9 cm (series 3, image 319), previously 4.4 x 3.8 cm. RETROPERITONEUM: The soft tissue mass along the left psoas muscle belly measures 2.4 x 1.8 cm (series 3, image 265), previously 2.3 x 1.6 cm. VESSELS: No significant abnormality. URINARY BLADDER: Surgically absent. REPRODUCTIVE ORGANS: The uterus is surgically absent. No adnexal mass lesions. BODY WALL: Ventral abdominal wall hernia which is mildly complex, but unchanged compared to prior. Right lower quadrant ileostomy redemonstrated. MUSCULOSKELETAL: No aggressive osseous lesions.
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2,712
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EXAM: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 246 mm. DLP: 1470.80 mGy cm. (accession CT220003232), Scan field of view: 220 mm. DLP: 1243.20 mGy cm. (accession CT220003238), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. DLP: 962.30 mGy cm. (accession CT220003233), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 247 mm. DLP: 1062.30 mGy cm. (accession CT220003239), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. (accession CT220003234) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: Scouts: No additional findings. Lines and tubes: Right IJ port catheter tip is in the right atrium as before. Lungs and pleura: No suspicious pulmonary nodules. Scattered calcified granulomas. No pulmonary consolidation. No pleural effusion. No pneumothorax. Esophagus, Mediastinum and neck: Esophagus is normal. Unchanged anterior mediastinal soft tissue, likely reactive thymus. The thyroid gland shows unchanged small nodule in the right lobe. Lymph Nodes: None enlarged. Cardiovascular: Filling defect along the right atrial appendage measures up to 20 mm (series 3 image 131), seen since at least June 21 CT, appears unchanged. Left vertebral artery arises from the aortic arch, normal variant. Coronary artery atherosclerotic calcification: None detected. Abdomen: Please refer to same day CT abdomen report for detailed findings below the diaphragm. Musculoskeletal/Body Wall: No soft tissue masses. No aggressive appearing skeletal lesions.
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2,713
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EXAM: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 246 mm. DLP: 1470.80 mGy cm. (accession CT220003232), Scan field of view: 220 mm. DLP: 1243.20 mGy cm. (accession CT220003238), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. DLP: 962.30 mGy cm. (accession CT220003233), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 247 mm. DLP: 1062.30 mGy cm. (accession CT220003239), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. (accession CT220003234) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Lower lobe subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Mild intrahepatic and severe extra hepatic biliary ductal dilation is similar to prior, tapering to normal in the pancreas head. GALLBLADDER: Absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Right adrenal adenoma is similar to prior. Left adrenal gland is unremarkable. KIDNEYS: Prominent extrarenal pelvises without hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis PERITONEUM / MESENTERY: No ascites. RETROPERITONEUM: Normal. VESSELS: Narrowing of the proximal left common iliac vein, possibly related to compression from the overlying right common iliac artery (image 172 series 2). The more distal common iliac vein is small in caliber but appears patent. There are calcifications in the distal left common iliac vein and proximal left external iliac vein, likely postthrombotic sequelae. Scattered atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. No adnexal masses. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Lower lumbar spine degenerative changes. Levoscoliotic curvature of the lumbar spine. No destructive osseous lesions seen.
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2,714
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EXAM: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 246 mm. DLP: 1470.80 mGy cm. (accession CT220003232), Scan field of view: 220 mm. DLP: 1243.20 mGy cm. (accession CT220003238), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. DLP: 962.30 mGy cm. (accession CT220003233), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 247 mm. DLP: 1062.30 mGy cm. (accession CT220003239), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. (accession CT220003234) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Normal. SOFT TISSUES: Subgaleal hematoma in the bilateral frontoparietal regions extending into the left occipital scalp. Extensive soft tissue swelling and fat stranding in the anterior fascial tissues.
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2,715
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EXAM: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 246 mm. DLP: 1470.80 mGy cm. (accession CT220003232), Scan field of view: 220 mm. DLP: 1243.20 mGy cm. (accession CT220003238), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. DLP: 962.30 mGy cm. (accession CT220003233), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 247 mm. DLP: 1062.30 mGy cm. (accession CT220003239), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. (accession CT220003234) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: Minimal bilateral dependent atelectasis. No pleural effusion or pneumothorax. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: No mediastinal hematoma. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture. Trace bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: No suspicious lesion identified. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable. PANCREAS: Normal. SPLEEN: Calcified granulomata. ADRENALS: Unremarkable. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops of small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. The appendix appears unremarkable PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Mild calcified atherosclerotic disease. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: Unremarkable. BODY WALL: Minimal fat-containing umbilical hernia. MUSCULOSKELETAL: There is avascular necrosis of the femoral heads. THORACIC SPINE: VERTEBRA: No acute fracture is identified. The patient is status post anterior fusion of the lower cervical spine. There are multilevel degenerative endplate changes and anterior osteophyte. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture is identified. There are degenerative endplate changes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Multilevel degenerative disc disease and facet arthropathy. ALIGNMENT: Normal.
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2,716
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EXAM: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrast, CT Chest with contrast, CT Cervical Spine From Reformat, CT Angio Neck, CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat 3-D CT MIP images were generated in post processing. Scan field of view: 246 mm. DLP: 1470.80 mGy cm. (accession CT220003232), Scan field of view: 220 mm. DLP: 1243.20 mGy cm. (accession CT220003238), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. DLP: 962.30 mGy cm. (accession CT220003233), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 247 mm. DLP: 1062.30 mGy cm. (accession CT220003239), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 480 mm. (accession CT220003234) FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. Scattered dental caries with periapical lucency involving left mandibular premolar tooth with overlying cortical erosion. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: Minimal bilateral dependent atelectasis. No pleural effusion or pneumothorax. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: No mediastinal hematoma. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture. Trace bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: No suspicious lesion identified. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable. PANCREAS: Normal. SPLEEN: Calcified granulomata. ADRENALS: Unremarkable. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops of small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. The appendix appears unremarkable PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Mild calcified atherosclerotic disease. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: Unremarkable. BODY WALL: Minimal fat-containing umbilical hernia. MUSCULOSKELETAL: There is avascular necrosis of the femoral heads. THORACIC SPINE: VERTEBRA: No acute fracture is identified. The patient is status post anterior fusion of the lower cervical spine. There are multilevel degenerative endplate changes and anterior osteophyte. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture is identified. There are degenerative endplate changes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Multilevel degenerative disc disease and facet arthropathy. ALIGNMENT: Normal.
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2,717
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CT Head wo+w contrast 1/6/2022 2:03 PM Clinical Information: dizziness, C50.211 Malignant neoplasm of upper-inner quadrant of right female breast Comparison: None Technique: Unenhanced axial brain CT. Bone and soft tissue windows were reviewed. Sagittal and coronal images were generated from the axial data. Post contrast images were also obtained. Patient weight: 174 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 180 sec. Scan field of view: 235 mm. DLP: 1597.07 mGy cm. Findings: Gray-white matter differentiation is maintained. No intracranial hemorrhage. No brain mass or mass effect. Postcontrast images demonstrate no enhancing intracranial masses. Mild ventriculomegaly without cerebral volume loss. Paranasal sinuses and mastoid cells are clear. No focal destructive osseous lesion. Visualized orbits appear within normal limits Impression: No acute intracranial abnormality. No CT evidence of intracranial metastases As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Gray-white matter differentiation is maintained. No intracranial hemorrhage. No brain mass or mass effect. Postcontrast images demonstrate no enhancing intracranial masses. Mild ventriculomegaly without cerebral volume loss. Paranasal sinuses and mastoid cells are clear. No focal destructive osseous lesion. Visualized orbits appear within normal limits
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,718
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Lung Cancer Screening Clinical Information: Lung cancer screening Technique: Scan field of view: 320 mm. Height: 64 in. Patient weight: 130 lbs. CTDI vol: 0.45 mGy. DLP: 19.30 mGy cm. 1.25 mm images were obtained through the chest. The CT is jointly interpreted by Drs. Terry and Singh Smoking Status: Current If not current, quit years ago: 0 Pack Years: 40 Screen Year: 1 Comparison: Chest CTA dated 12/18/2020 Interpretation and recommendations are based on 2019 version of ACR LungRads recommendations Findings: No enlarged hilar or mediastinal nodes are present. Calcified AP window nodes are seen. Calcific atherosclerosis is present in the aorta. Post CABG findings are seen. The mediastinum is otherwise normal. Upper lobe predominant centrilobular and paraseptal emphysema is redemonstrated. Small area of scarring is seen in the anterior LUL associated with interval CABG . Mild bronchiectasis is noted. A calcified granuloma is present in the LLL. A tiny peripheral RLL nodule is seen on series 2 image 156 and appears unchanged from exam on 2/24/2014. A few tiny fissural nodules along the left major fissure are also noted. Coronary artery calcification, patient has had a previous CABG . The visualized liver, spleen, adrenals, and bowel are unremarkable. Calyceal calcifications are seen in the left kidney. Bones: Interval sternotomy since 2020 with nonfusion of the sternum. No lytic or blastic lesions. Impression: 1. No nodule suspicious for malignancy. 2. Emphysema and mild bronchiectasis. 3. Interval CABG. LungRads category: 2 Lung-Rads Modifier S: No clinically significant or potentially clinically significant findings. Recommendation: Return in 12 months for routine low-dose lung cancer screening chest CT ====================================================================================== REFERENCES: http://www.acr.org/\R\/media/ACR/Documents/PDF/QualitySafety/Resources/LungRADS/AssessmentCateg ries http://www.acr.org/Quality-Safety/Lung-Cancer-Screening-Center Category 0: Incomplete. Category 1: Negative - No nodules or definitely benign nodules. Category 2: Benign Appearance or Behavior - Nodules with a very low likelihood of becoming a clinically active cancer due to size or lack of growth. Category 3: Probably benign finding(s) - Short term follow-up suggested; includes nodules with a low likelihood of becoming a clinically active cancer. Category 4A: Suspicious - Findings for which additional diagnostic testing is recommended. Category 4B and 4X: Very Suspicious - Findings for which additional diagnostic testing and/or tissue sampling is recommended. Modifier S: Other Findings - Clinically significant or potentially clinically significant findings (non-lung cancer). References: http://www.acr.org/\R\/media/ACR/Documents/PDF/QualitySafety/Resources/LungRADS/AssessmentCateg ries http://www.acr.org/Quality-Safety/Lung-Cancer-Screening-Center
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Findings: No enlarged hilar or mediastinal nodes are present. Calcified AP window nodes are seen. Calcific atherosclerosis is present in the aorta. Post CABG findings are seen. The mediastinum is otherwise normal. Upper lobe predominant centrilobular and paraseptal emphysema is redemonstrated. Small area of scarring is seen in the anterior LUL associated with interval CABG . Mild bronchiectasis is noted. A calcified granuloma is present in the LLL. A tiny peripheral RLL nodule is seen on series 2 image 156 and appears unchanged from exam on 2/24/2014. A few tiny fissural nodules along the left major fissure are also noted. Coronary artery calcification, patient has had a previous CABG . The visualized liver, spleen, adrenals, and bowel are unremarkable. Calyceal calcifications are seen in the left kidney. Bones: Interval sternotomy since 2020 with nonfusion of the sternum. No lytic or blastic lesions.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: Minimal bilateral dependent atelectasis. No pleural effusion or pneumothorax. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: No mediastinal hematoma. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture. Trace bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: No suspicious lesion identified. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable. PANCREAS: Normal. SPLEEN: Calcified granulomata. ADRENALS: Unremarkable. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops of small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. The appendix appears unremarkable PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Mild calcified atherosclerotic disease. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: Unremarkable. BODY WALL: Minimal fat-containing umbilical hernia. MUSCULOSKELETAL: There is avascular necrosis of the femoral heads. THORACIC SPINE: VERTEBRA: No acute fracture is identified. The patient is status post anterior fusion of the lower cervical spine. There are multilevel degenerative endplate changes and anterior osteophyte. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture is identified. There are degenerative endplate changes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Multilevel degenerative disc disease and facet arthropathy. ALIGNMENT: Normal.
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2,719
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: 44-year-old female, COVID positive, evaluation for pulmonary embolism. COMPARISON: Chest radiograph 12/30/2021; CT angiogram chest 8/2/2021 TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 160 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 70 ml. IV contrast injection rate: 3 ml per sec. Scan delay: bolus tracked Scan field of view: 322 mm. KVP: 100 DLP: 155.80 mGy cm. FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: Multiple thyroid nodules, the thyroid appears enlarged and several of the thyroid nodules are calcified including a retrosternal left-sided goiter. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Central airways are patent. Diffuse interlobular septal thickening and groundglass opacities are demonstrated throughout all lung fields. Some consolidative opacities in the right lower lobe are improved from prior and there is a nodule in the right lower lobe measuring 7 mm axial image 58 series 401, stable in comparison to November 30, 2020 exam. Bibasilar atelectatic changes. No pneumothorax. Trace bilateral pleural effusions. HEART / OTHER VESSELS: Mild cardiomegaly. Enlarged main pulmonary artery. Contrast reflux into the IVC and hepatic veins. There are mitral annular calcifications and coronary atherosclerotic calcifications. MEDIASTINUM / ESOPHAGUS: No significant abnormality. LYMPH NODES: Enlarged mediastinal, paratracheal, and subcarinal lymphadenopathy, similar to prior exams. The right axillary lymphadenopathy is also demonstrated and appears increased from prior. CHEST WALL: Mild chest wall anasarca. There is asymmetric appearance of right breast tissue compared with the left. UPPER ABDOMEN: Partially visualized right upper renal pole cysts and again demonstrated are indeterminate renal lesions. No other significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No evidence of pulmonary embolism. 2. Diffuse septal thickening and groundglass opacities along with trace bilateral pleural effusions are compatible with pulmonary edema although other differential considerations are not excluded. Enlarged main pulmonary artery which can be seen with pulmonary arterial hypertension. Mild cardiomegaly. Contrast reflux into the IVC and hepatic veins is compatible with right heart dysfunction. 3. Multinodular thyroid goiter. 4. There is right axillary lymphadenopathy which appears worsened from prior. Lymphadenopathy is indeterminate and malignancy is not excluded. Mediastinal and hilar lymphadenopathy is again demonstrated, grossly stable, but indeterminate. There is also asymmetric appearance of the right breast tissue with skin thickening and increased stranding in the right breast. Recommend correlation for cellulitis and/or malignancy. Recommend consideration for breast imaging clinic follow-up. 5. The 7 mm right lower lobe lung nodule is stable from prior exams, indeterminate and recommend 6-12 month CT follow-up. Other chronic and incidental findings as above. Dr. Eversull in the ED notified by Dr. Spann at 10:14 PM January 6, 2022. *****IMPORTANT INCIDENTAL IMAGING FINDINGS REPORTED***** As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Full diagnostic quality LOWER NECK: Multiple thyroid nodules, the thyroid appears enlarged and several of the thyroid nodules are calcified including a retrosternal left-sided goiter. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Central airways are patent. Diffuse interlobular septal thickening and groundglass opacities are demonstrated throughout all lung fields. Some consolidative opacities in the right lower lobe are improved from prior and there is a nodule in the right lower lobe measuring 7 mm axial image 58 series 401, stable in comparison to November 30, 2020 exam. Bibasilar atelectatic changes. No pneumothorax. Trace bilateral pleural effusions. HEART / OTHER VESSELS: Mild cardiomegaly. Enlarged main pulmonary artery. Contrast reflux into the IVC and hepatic veins. There are mitral annular calcifications and coronary atherosclerotic calcifications. MEDIASTINUM / ESOPHAGUS: No significant abnormality. LYMPH NODES: Enlarged mediastinal, paratracheal, and subcarinal lymphadenopathy, similar to prior exams. The right axillary lymphadenopathy is also demonstrated and appears increased from prior. CHEST WALL: Mild chest wall anasarca. There is asymmetric appearance of right breast tissue compared with the left. UPPER ABDOMEN: Partially visualized right upper renal pole cysts and again demonstrated are indeterminate renal lesions. No other significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Unremarkable. CHEST: LUNGS / AIRWAYS / PLEURA: Minimal bilateral dependent atelectasis. No pleural effusion or pneumothorax. The central airways are patent. HEART / VESSELS: The heart is normal in size. MEDIASTINUM / ESOPHAGUS: No mediastinal hematoma. The esophagus appears unremarkable. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture. Trace bilateral gynecomastia. ABDOMEN and PELVIS: LIVER: No suspicious lesion identified. BILIARY TRACT: Normal. GALLBLADDER: Unremarkable. PANCREAS: Normal. SPLEEN: Calcified granulomata. ADRENALS: Unremarkable. KIDNEYS: No hydronephrosis, suspicious mass or laceration. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops of small bowel are normal in caliber. COLON / APPENDIX: No evidence of acute colonic pathology. The appendix appears unremarkable PERITONEUM / MESENTERY: No free fluid or free air. RETROPERITONEUM: Normal. VESSELS: Mild calcified atherosclerotic disease. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: Unremarkable. BODY WALL: Minimal fat-containing umbilical hernia. MUSCULOSKELETAL: There is avascular necrosis of the femoral heads. THORACIC SPINE: VERTEBRA: No acute fracture is identified. The patient is status post anterior fusion of the lower cervical spine. There are multilevel degenerative endplate changes and anterior osteophyte. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No acute fracture is identified. There are degenerative endplate changes. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Multilevel degenerative disc disease and facet arthropathy. ALIGNMENT: Normal.
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2,720
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CT Orbit or Temporal Bones with contrast 1/6/2022 2:50 PM Clinical Information: Mastoiditis Comparison: None Technique: Axial helical CT images were obtained through the maxillofacial region. 2-D coronal reconstructions were generated from the axial data. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 180 sec. Scan field of view: 181 mm. DLP: 763.70 mGy cm. Findings: There are bilateral mastoid effusions as well as opacification of the bilateral middle ear. The ossicles appear grossly intact. The external auditory canals appear patent. There is no definite osseous destruction. No acute fracture or dislocation is seen. No definite abnormal enhancement. There is moderate mucosal thickening and fluid seen within the right maxillary sinus. There is mucosal thickening in the anterior ethmoids bilaterally as well as a small amount seen in the left maxillary sinus. There is minimal/mild mucosal thickening seen in the bilateral frontal and sphenoid sinuses. The bilateral orbits are unremarkable. There is a low attenuated extra-axial lesion in the left middle cranial fossa, possibly an arachnoid cyst, incompletely evaluated. Conclusion: 1. Bilateral otomastoiditis. 2. Extensive paranasal sinus disease most pronounced in the right maxillary sinus. 3. Extra-axial lesion in the left middle cranial fossa, possibly an arachnoid cyst.
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Findings: There are bilateral mastoid effusions as well as opacification of the bilateral middle ear. The ossicles appear grossly intact. The external auditory canals appear patent. There is no definite osseous destruction. No acute fracture or dislocation is seen. No definite abnormal enhancement. There is moderate mucosal thickening and fluid seen within the right maxillary sinus. There is mucosal thickening in the anterior ethmoids bilaterally as well as a small amount seen in the left maxillary sinus. There is minimal/mild mucosal thickening seen in the bilateral frontal and sphenoid sinuses. The bilateral orbits are unremarkable. There is a low attenuated extra-axial lesion in the left middle cranial fossa, possibly an arachnoid cyst, incompletely evaluated.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Normal. SOFT TISSUES: Subgaleal hematoma in the bilateral frontoparietal regions extending into the left occipital scalp. Extensive soft tissue swelling and fat stranding in the anterior fascial tissues.
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2,721
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: ams COMPARISON: 11/30/2021 TECHNIQUE: CT Head wo contrastScan field of view: 270.70 mm. DLP: 1389.40 mGy cm. FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Advanced global atrophy and chronic small vessel ischemic change. Remote lacunar type infarcts in the right internal capsule/corona radiata, thalamus and pons. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Right maxillary retention cyst versus polyp. MASTOIDS: Clear. SOFT TISSUE: Unremarkable. CONCLUSION: No acute intracranial process.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Advanced global atrophy and chronic small vessel ischemic change. Remote lacunar type infarcts in the right internal capsule/corona radiata, thalamus and pons. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Right maxillary retention cyst versus polyp. MASTOIDS: Clear. SOFT TISSUE: Unremarkable.
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,722
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Left flank pain. COVID confirmed COMPARISON: 12/24/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 140 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 350 mm. DLP: 431 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small subcentimeter hypodensity within the lower pole the left kidney is technically indeterminate but likely a cyst, unchanged. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not well-visualized but there are no secondary signs of appendicitis. There are few scattered noninflamed colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate severe aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Collapsed with mild mucosal enhancement REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: Rectus diastases MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. No focal destructive osseous lesion is identified. CONCLUSION: 1. Findings concerning for cystitis/UTI. 2. Hepatic steatosis. Additional findings above.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Hepatic steatosis. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Small subcentimeter hypodensity within the lower pole the left kidney is technically indeterminate but likely a cyst, unchanged. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: The appendix is not well-visualized but there are no secondary signs of appendicitis. There are few scattered noninflamed colonic diverticula. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate severe aortoiliac atherosclerosis without aneurysmal dilatation. URINARY BLADDER: Collapsed with mild mucosal enhancement REPRODUCTIVE ORGANS: Hysterectomy changes are noted. No adnexal mass. BODY WALL: Rectus diastases MUSCULOSKELETAL: Mild degenerative changes are seen within the spine. No focal destructive osseous lesion is identified.
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FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. There is bilateral basal ganglia mineralization. Multiple right middle cranial fossa aneurysm clips are again noted. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: There are postoperative changes of the right frontotemporal calvarium. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Mastoid air cells and paranasal sinuses are well aerated. There is calcified atherosclerotic disease of the cavernous carotid arteries.
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2,723
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Known sacral wound and osteomyelitis COMPARISON: CT 12/07/2021 CT pelvis 12/31/2021. TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 371 mm. DLP: 538.50 mGy cm. Patient had contrast extravasation of about 40 cc in the left arm. Multiple attempts are performed for IV access without any success. Hence only CT without intravenous contrast was performed. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Linear bibasilar subsegmental atelectasis. No pleural effusion, consolidation or pneumothorax. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Heart is normal in size. A small pericardial effusion. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Several enlarged reactive pelvic lymph nodes as seen before. STOMACH / SMALL BOWEL: Small hiatal hernia. Stomach is moderately distended. No abnormal dilatation small bowel loops. COLON / APPENDIX: Moderate amount of retained colonic stool. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially distended and demonstrates suprapubic catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Large dependent sacral decubitus ulcer as seen with extensive gas extending into the sacroiliac joints, bilateral gluteal region, and left iliopsoas musculature. Redemonstrated extensive subchondral gas at the sacroiliac joints with destructive changes, left greater than right. Soft tissue thickening in the left iliacus from recent percutaneous drainage. There is extensive gluteal soft tissue edema, and diffuse body wall edema. MUSCULOSKELETAL: L3-L4 discitis osteomyelitis redemonstrated. Lumbar vertebrae demonstrate normal height. Extensive exuberant heterotopic soft tissue ossification at the joints, and in the region of ischial tuberosities. CONCLUSION: 1. There was intravenous contrast extravasation in the left upper arm. Multiple additional attempts are performed without any success for IV access. Hence CT study was performed without intravenous contrast. 2. No significant interval change compared to recent CT pelvis 12/31/2021. Extensive, large bilateral gluteal/dependent sacral ulcers with extensive necrotizing infection extending into the sequela joints, gluteal spaces. L3-L4 discitis-osteomyelitis. Recently drained left iliacus abscess with persistent mild soft tissue thickening. Diffuse body wall edema. 3. No new intra-abdominal fluid collection. Other stable findings as described above.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Linear bibasilar subsegmental atelectasis. No pleural effusion, consolidation or pneumothorax. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Heart is normal in size. A small pericardial effusion. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Several enlarged reactive pelvic lymph nodes as seen before. STOMACH / SMALL BOWEL: Small hiatal hernia. Stomach is moderately distended. No abnormal dilatation small bowel loops. COLON / APPENDIX: Moderate amount of retained colonic stool. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Partially distended and demonstrates suprapubic catheter. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Large dependent sacral decubitus ulcer as seen with extensive gas extending into the sacroiliac joints, bilateral gluteal region, and left iliopsoas musculature. Redemonstrated extensive subchondral gas at the sacroiliac joints with destructive changes, left greater than right. Soft tissue thickening in the left iliacus from recent percutaneous drainage. There is extensive gluteal soft tissue edema, and diffuse body wall edema. MUSCULOSKELETAL: L3-L4 discitis osteomyelitis redemonstrated. Lumbar vertebrae demonstrate normal height. Extensive exuberant heterotopic soft tissue ossification at the joints, and in the region of ischial tuberosities.
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis Renal Donor RIGHT KIDNEY: - RENAL ARTERY: Single. - RENAL VEIN: Single. - COLLECTING SYSTEM: Single. - RENAL CALCULI: Absent. - CYSTS/MASSES: Absent. - VOLUME: 143 cm\S\3 LEFT KIDNEY: - RENAL ARTERY: Single. - RENAL VEIN: Single with conventional pre-aortic anatomy. - COLLECTING SYSTEM: Single. - RENAL CALCULI: Absent. - CYSTS/MASSES: Absent. - VOLUME: 157 cm\S\3 ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: Dilated left gonadal vein measuring up to 1 cm (series 10 image 53) with multiple dilated left periuterine collateral vessels. Findings are nonspecific but can be seen in the clinical setting of pelvic congestion syndrome. URINARY BLADDER: Decompressed REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small right indirect inguinal hernia. MUSCULOSKELETAL: Multilevel degenerative changes in the lumbar spine.
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2,724
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: Shortness of breath. Lung transplant status. COMPARISON: 8/26/2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 361 mm. DLP: 283 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Previously seen airspace opacities in the transplanted left lower lung have resolved. Severe emphysematous changes and hyperinflation of the right lung are again seen. Atelectatic changes at the right lung base. HEART / VESSELS: Mild coronary artery calcifications. Small unchanged pericardial effusion. MEDIASTINUM / ESOPHAGUS: Mediastinum is shifted to the left secondary to the hyperinflated right lung. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Unchanged right renal upper pole cyst. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Interval resolution of the previously seen left lower lobe airspace opacities. Severe emphysematous changes, bullae, and hypertrophy of the native right lung with mediastinal shift to the left again seen. Other noncontributory incidental findings are unchanged.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Previously seen airspace opacities in the transplanted left lower lung have resolved. Severe emphysematous changes and hyperinflation of the right lung are again seen. Atelectatic changes at the right lung base. HEART / VESSELS: Mild coronary artery calcifications. Small unchanged pericardial effusion. MEDIASTINUM / ESOPHAGUS: Mediastinum is shifted to the left secondary to the hyperinflated right lung. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Unchanged right renal upper pole cyst. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Trace left basilar scarring/atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Scattered calcifications along the LAD. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Contracted. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Underdistended stomach, limiting evaluation. Small bowel anastomosis in left side of the abdomen is patent. Fluid-filled loops of small bowel throughout the abdomen without discrete transition point. Small bowel feces in the terminal ileum suggests prolonged transit time. COLON / APPENDIX: Thick-walled, dilated appendix measures up to 1.4 cm. There is adjacent stranding and small volume free fluid. Moderate colonic fecal burden. Diverticulosis. PERITONEUM / MESENTERY: Infiltrative soft tissue density in the left upper mesentery is redemonstrated, with discrete nodule measuring approximately 1.7 x 1.3 cm, similar to prior. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Postsurgical changes. MUSCULOSKELETAL: Small focal exostosis along the posterior margin of the right ilium. Bony bridging across the bilateral sacroiliac joints. No aggressive osseous lesion is identified.
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2,725
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EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast CLINICAL INFORMATION: Fall COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast. Patient weight: 105 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. (accession CT220003249), Patient weight: 105 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. DLP: 481.40 mGy cm. (accession CT220003248) FINDINGS: LOWER NECK: Mildly enlarged thyroid gland with 8 mm nodule in the isthmus and additional smaller right thyroid nodule. CHEST: LUNGS / AIRWAYS / PLEURA: Moderate right pleural effusion with overlying atelectasis. 1.0 cm nodular focus of consolidation in the right lower lobe on image 171, series 501. No acute injury. No pneumothorax or left pleural effusion. HEART / VESSELS: Trace pericardial fluid. Three-vessel coronary calcifications. Moderate short segment atherosclerotic narrowing of the proximal subclavian artery. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left renal cysts and additional subcentimeter hypoattenuating renal lesions are too small to characterize but likely also cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderately advanced aortoiliac atherosclerotic disease with borderline aneurysmal dilation of the infrarenal abdominal aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic sternal manubrial fracture. Additional subacute to chronic fractures involving the right C7 facet, thoracic spine transverse processes, and right ribs again visualized. Additional subacute to chronic fractures of the right pubic body and obturator ring, right sacrum and right posterior ilium with transsacral screw without hardware complication. Compression fracture with approximately 25% vertebral body height loss. Right hip arthroplasty without complication. No acute fracture. CONCLUSION: 1. Indeterminate aged L1 compression fracture. Correlate with patient symptoms and point tenderness. 2. Otherwise no acute traumatic injury within the chest, abdomen, or pelvis. 3. 1.0 cm nodular focus of consolidation/nodule in the right lower lobe. Recommend follow-up chest CT in 3 months. 4. Moderate right pleural effusion. 5. Multiple subacute to chronic fractures, borderline infrarenal abdominal aortic aneurysm, and additional chronic/incidental findings as above. *****IMPORTANT INCIDENTAL IMAGING FINDINGS REPORTED***** -Recommended 3 month chest CT follow-up.
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FINDINGS: LOWER NECK: Mildly enlarged thyroid gland with 8 mm nodule in the isthmus and additional smaller right thyroid nodule. CHEST: LUNGS / AIRWAYS / PLEURA: Moderate right pleural effusion with overlying atelectasis. 1.0 cm nodular focus of consolidation in the right lower lobe on image 171, series 501. No acute injury. No pneumothorax or left pleural effusion. HEART / VESSELS: Trace pericardial fluid. Three-vessel coronary calcifications. Moderate short segment atherosclerotic narrowing of the proximal subclavian artery. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left renal cysts and additional subcentimeter hypoattenuating renal lesions are too small to characterize but likely also cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderately advanced aortoiliac atherosclerotic disease with borderline aneurysmal dilation of the infrarenal abdominal aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic sternal manubrial fracture. Additional subacute to chronic fractures involving the right C7 facet, thoracic spine transverse processes, and right ribs again visualized. Additional subacute to chronic fractures of the right pubic body and obturator ring, right sacrum and right posterior ilium with transsacral screw without hardware complication. Compression fracture with approximately 25% vertebral body height loss. Right hip arthroplasty without complication. No acute fracture.
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There are periventricular low-attenuation white matter changes, likely small vessel ischemic evaluation is limited by motion artifact disease. There is bilateral basal ganglia mineralization. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. There is s calcified atherosclerotic disease of the vertebral and cavernous carotid arteries. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is bilateral pseudophakia. No retrobulbar hemorrhage is noted. There is a mucous retention cysts/polyps in the bilateral maxillary sinuses. There is mucosal thickening in bilateral sphenoid and ethmoid sinuses. The mastoid air cells are aerated. CERVICAL SPINE:. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,726
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EXAM: CT Abdomen and Pelvis w contrast, CT Chest with contrast CLINICAL INFORMATION: Fall COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Chest with contrast. Patient weight: 105 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. (accession CT220003249), Patient weight: 105 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. DLP: 481.40 mGy cm. (accession CT220003248) FINDINGS: LOWER NECK: Mildly enlarged thyroid gland with 8 mm nodule in the isthmus and additional smaller right thyroid nodule. CHEST: LUNGS / AIRWAYS / PLEURA: Moderate right pleural effusion with overlying atelectasis. 1.0 cm nodular focus of consolidation in the right lower lobe on image 171, series 501. No acute injury. No pneumothorax or left pleural effusion. HEART / VESSELS: Trace pericardial fluid. Three-vessel coronary calcifications. Moderate short segment atherosclerotic narrowing of the proximal subclavian artery. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left renal cysts and additional subcentimeter hypoattenuating renal lesions are too small to characterize but likely also cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderately advanced aortoiliac atherosclerotic disease with borderline aneurysmal dilation of the infrarenal abdominal aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic sternal manubrial fracture. Additional subacute to chronic fractures involving the right C7 facet, thoracic spine transverse processes, and right ribs again visualized. Additional subacute to chronic fractures of the right pubic body and obturator ring, right sacrum and right posterior ilium with transsacral screw without hardware complication. Compression fracture with approximately 25% vertebral body height loss. Right hip arthroplasty without complication. No acute fracture. CONCLUSION: 1. Indeterminate aged L1 compression fracture. Correlate with patient symptoms and point tenderness. 2. Otherwise no acute traumatic injury within the chest, abdomen, or pelvis. 3. 1.0 cm nodular focus of consolidation/nodule in the right lower lobe. Recommend follow-up chest CT in 3 months. 4. Moderate right pleural effusion. 5. Multiple subacute to chronic fractures, borderline infrarenal abdominal aortic aneurysm, and additional chronic/incidental findings as above. *****IMPORTANT INCIDENTAL IMAGING FINDINGS REPORTED***** -Recommended 3 month chest CT follow-up.
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FINDINGS: LOWER NECK: Mildly enlarged thyroid gland with 8 mm nodule in the isthmus and additional smaller right thyroid nodule. CHEST: LUNGS / AIRWAYS / PLEURA: Moderate right pleural effusion with overlying atelectasis. 1.0 cm nodular focus of consolidation in the right lower lobe on image 171, series 501. No acute injury. No pneumothorax or left pleural effusion. HEART / VESSELS: Trace pericardial fluid. Three-vessel coronary calcifications. Moderate short segment atherosclerotic narrowing of the proximal subclavian artery. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Left renal cysts and additional subcentimeter hypoattenuating renal lesions are too small to characterize but likely also cysts. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderately advanced aortoiliac atherosclerotic disease with borderline aneurysmal dilation of the infrarenal abdominal aorta. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Chronic sternal manubrial fracture. Additional subacute to chronic fractures involving the right C7 facet, thoracic spine transverse processes, and right ribs again visualized. Additional subacute to chronic fractures of the right pubic body and obturator ring, right sacrum and right posterior ilium with transsacral screw without hardware complication. Compression fracture with approximately 25% vertebral body height loss. Right hip arthroplasty without complication. No acute fracture.
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There are periventricular low-attenuation white matter changes, likely small vessel ischemic evaluation is limited by motion artifact disease. There is bilateral basal ganglia mineralization. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. There is s calcified atherosclerotic disease of the vertebral and cavernous carotid arteries. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is bilateral pseudophakia. No retrobulbar hemorrhage is noted. There is a mucous retention cysts/polyps in the bilateral maxillary sinuses. There is mucosal thickening in bilateral sphenoid and ethmoid sinuses. The mastoid air cells are aerated. CERVICAL SPINE:. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,727
|
RADIOLOGIC EXAM: CT Angio Neck CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck 3-D CT MIP and Volume rendered angiographic images were generated in post processing. Patient weight: 105 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 247 mm. DLP: 960.50 mGy cm. FINDINGS: Mild to moderate carotid atherosclerotic disease without flow-limiting stenosis. Mild atherosclerotic narrowing of the proximal left subclavian artery. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: No evidence of occlusion, dissection, or aneurysm. LEFT CAROTID: No evidence of dissection, aneurysm, or occlusion. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. CONCLUSION: Patent cervical arterial vasculature without acute injury.
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FINDINGS: Mild to moderate carotid atherosclerotic disease without flow-limiting stenosis. Mild atherosclerotic narrowing of the proximal left subclavian artery. AORTIC ARCH and PROXIMAL GREAT VESSELS: Unremarkable. RIGHT CAROTID: No evidence of occlusion, dissection, or aneurysm. LEFT CAROTID: No evidence of dissection, aneurysm, or occlusion. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified.
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There are periventricular low-attenuation white matter changes, likely small vessel ischemic evaluation is limited by motion artifact disease. There is bilateral basal ganglia mineralization. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. There is s calcified atherosclerotic disease of the vertebral and cavernous carotid arteries. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is bilateral pseudophakia. No retrobulbar hemorrhage is noted. There is a mucous retention cysts/polyps in the bilateral maxillary sinuses. There is mucosal thickening in bilateral sphenoid and ethmoid sinuses. The mastoid air cells are aerated. CERVICAL SPINE:. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,728
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 69-year-old male with nausea vomiting and abdominal pain; history of renal stones. COMPARISON: CT abdomen pelvis 3/15/2013 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 186 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 370 mm. DLP: 916.30 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Right basilar subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Peripancreatic stranding without focal lesion or parenchymal abnormality. SPLEEN: Calcified parenchymal granulomas. ADRENALS: Normal. KIDNEYS: Bilateral simple renal cysts. Additional subcentimeter hypoattenuating structures are technically indeterminate but most suggestive of cysts. Punctate bilateral nonobstructing calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Mild periduodenal stranding, likely reactive. COLON / APPENDIX: Few colonic diverticuli without associated inflammation. Mild amount of mesocolic stranding adjacent to the splenic flexure of the colon, likely reactive. PERITONEUM / MESENTERY: Moderate peripancreatic stranding with small amount of unorganized fluid along the pararenal space bilaterally RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Moderate atherosclerotic disease. IVC filter in place. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Bilateral hip arthroplasties produce streak artifact which limits evaluation of the lower pelvis. Diffusely decreased bone mineralization. Multilevel endplate and facet degenerative changes are present. CONCLUSION: 1. Peripancreatic stranding and fluid, suggestive of acute interstitial pancreatitis. No organized fluid collections. 2. Periduodenal and pericolonic stranding, likely reactive and associated with underlying pancreatitis. 3. Punctate bilateral nonobstructive nephrolithiasis.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Right basilar subsegmental atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Peripancreatic stranding without focal lesion or parenchymal abnormality. SPLEEN: Calcified parenchymal granulomas. ADRENALS: Normal. KIDNEYS: Bilateral simple renal cysts. Additional subcentimeter hypoattenuating structures are technically indeterminate but most suggestive of cysts. Punctate bilateral nonobstructing calculi. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Mild periduodenal stranding, likely reactive. COLON / APPENDIX: Few colonic diverticuli without associated inflammation. Mild amount of mesocolic stranding adjacent to the splenic flexure of the colon, likely reactive. PERITONEUM / MESENTERY: Moderate peripancreatic stranding with small amount of unorganized fluid along the pararenal space bilaterally RETROPERITONEUM: Normal. VESSELS: Normal caliber abdominal aorta. Moderate atherosclerotic disease. IVC filter in place. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Bilateral hip arthroplasties produce streak artifact which limits evaluation of the lower pelvis. Diffusely decreased bone mineralization. Multilevel endplate and facet degenerative changes are present.
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There are periventricular low-attenuation white matter changes, likely small vessel ischemic evaluation is limited by motion artifact disease. There is bilateral basal ganglia mineralization. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. There is s calcified atherosclerotic disease of the vertebral and cavernous carotid arteries. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is bilateral pseudophakia. No retrobulbar hemorrhage is noted. There is a mucous retention cysts/polyps in the bilateral maxillary sinuses. There is mucosal thickening in bilateral sphenoid and ethmoid sinuses. The mastoid air cells are aerated. CERVICAL SPINE:. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,729
|
EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 75-year-old female with metastatic breast cancer. COMPARISON: CT 10/12/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 120 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 1.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 340 mm. DLP: 671.33 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Layering hyperdensity represents stones or sludge. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. Ovaries are normal in size and appearance. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Unchanged diffuse sclerotic osseous metastatic disease. CONCLUSION: Unchanged diffuse sclerotic osseous metastatic disease. No soft tissue metastatic disease in the abdomen or pelvis.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Layering hyperdensity represents stones or sludge. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is absent. Ovaries are normal in size and appearance. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Unchanged diffuse sclerotic osseous metastatic disease.
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There are periventricular low-attenuation white matter changes, likely small vessel ischemic evaluation is limited by motion artifact disease. There is bilateral basal ganglia mineralization. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. There is s calcified atherosclerotic disease of the vertebral and cavernous carotid arteries. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is bilateral pseudophakia. No retrobulbar hemorrhage is noted. There is a mucous retention cysts/polyps in the bilateral maxillary sinuses. There is mucosal thickening in bilateral sphenoid and ethmoid sinuses. The mastoid air cells are aerated. CERVICAL SPINE:. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,730
|
EXAM: CT Chest with contrast CLINICAL INFORMATION: Metastatic breast cancer. Restaging scans. COMPARISON: 10/12/2021 TECHNIQUE: CT Chest with contrast. Patient weight: 120 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 1.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 340 mm. DLP: 671.33 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild biapical scarring. A couple of tiny nonspecific less than 0.3 cm pulmonary nodules in the right lung are unchanged. HEART / VESSELS: Mild coronary artery calcifications. Aortic valve calcifications without significant dilation of the ascending aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. MUSCULOSKELETAL: Scattered sclerotic metastases are not significantly changed. CONCLUSION: No intrathoracic metastatic disease. Osseous metastatic disease is unchanged. A couple of nonspecific, tiny pulmonary nodules are unchanged.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Mild biapical scarring. A couple of tiny nonspecific less than 0.3 cm pulmonary nodules in the right lung are unchanged. HEART / VESSELS: Mild coronary artery calcifications. Aortic valve calcifications without significant dilation of the ascending aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. MUSCULOSKELETAL: Scattered sclerotic metastases are not significantly changed.
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There are periventricular low-attenuation white matter changes, likely small vessel ischemic evaluation is limited by motion artifact disease. There is bilateral basal ganglia mineralization. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. There is s calcified atherosclerotic disease of the vertebral and cavernous carotid arteries. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is bilateral pseudophakia. No retrobulbar hemorrhage is noted. There is a mucous retention cysts/polyps in the bilateral maxillary sinuses. There is mucosal thickening in bilateral sphenoid and ethmoid sinuses. The mastoid air cells are aerated. CERVICAL SPINE:. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,731
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: Chest pain or shortness of breath, pleurisy or effusion suspected. Pneumonia. COMPARISON: None. TECHNIQUE: CT Chest wo contrast. Scan field of view: 390 mm. DLP: 218 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small right pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Mild circumferential thickening of the distal esophagus may reflect reflux esophagitis. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Heterogenous appearance of the liver with several low-attenuation lesions, poorly evaluated on this noncontrast examination. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Small right pleural effusion. 2. Heterogenous appearance of the liver with several poorly evaluated low-attenuation lesions. Laboratory correlation and further evaluation with abdominal ultrasound is recommended.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small right pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Mild circumferential thickening of the distal esophagus may reflect reflux esophagitis. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Heterogenous appearance of the liver with several low-attenuation lesions, poorly evaluated on this noncontrast examination. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There are periventricular low-attenuation white matter changes, likely small vessel ischemic evaluation is limited by motion artifact disease. There is bilateral basal ganglia mineralization. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. There is s calcified atherosclerotic disease of the vertebral and cavernous carotid arteries. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is bilateral pseudophakia. No retrobulbar hemorrhage is noted. There is a mucous retention cysts/polyps in the bilateral maxillary sinuses. There is mucosal thickening in bilateral sphenoid and ethmoid sinuses. The mastoid air cells are aerated. CERVICAL SPINE:. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,732
|
RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 248 mm. DLP: 1516.90 mGy cm. (accession CT220003256), Scan field of view: 244 mm. DLP: 1201.80 mGy cm. (accession CT220003257) STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Left globe rupture with few foci of intraconal gas in the left orbit as as well as left periorbital contusion?. SINUSES: Mild maxillary sinus mucosal disease. MAXILLOFACIAL: Indeterminate aged right nasal bone fracture. Additional fracture of the left lamina papyracea/medial orbital wall with small amount of extraconal fat herniating through the fracture defect. Periapical lucency involving right maxillary premolar tooth. CONCLUSION: 1. Left globe rupture 2. Indeterminate aged right nasal bone and left lamina papyracea/medial orbital wall fractures. 3. No acute intracranial abnormality.
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FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Left globe rupture with few foci of intraconal gas in the left orbit as as well as left periorbital contusion?. SINUSES: Mild maxillary sinus mucosal disease. MAXILLOFACIAL: Indeterminate aged right nasal bone fracture. Additional fracture of the left lamina papyracea/medial orbital wall with small amount of extraconal fat herniating through the fracture defect. Periapical lucency involving right maxillary premolar tooth.
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There are periventricular low-attenuation white matter changes, likely small vessel ischemic evaluation is limited by motion artifact disease. There is bilateral basal ganglia mineralization. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. There is s calcified atherosclerotic disease of the vertebral and cavernous carotid arteries. MAXILLOFACIAL: There are no acute maxillofacial or mandibular fractures. There is bilateral pseudophakia. No retrobulbar hemorrhage is noted. There is a mucous retention cysts/polyps in the bilateral maxillary sinuses. There is mucosal thickening in bilateral sphenoid and ethmoid sinuses. The mastoid air cells are aerated. CERVICAL SPINE:. SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,733
|
RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 248 mm. DLP: 1516.90 mGy cm. (accession CT220003256), Scan field of view: 244 mm. DLP: 1201.80 mGy cm. (accession CT220003257) STRUCTURED REPORT: CT Head FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Left globe rupture with few foci of intraconal gas in the left orbit as as well as left periorbital contusion?. SINUSES: Mild maxillary sinus mucosal disease. MAXILLOFACIAL: Indeterminate aged right nasal bone fracture. Additional fracture of the left lamina papyracea/medial orbital wall with small amount of extraconal fat herniating through the fracture defect. Periapical lucency involving right maxillary premolar tooth. CONCLUSION: 1. Left globe rupture 2. Indeterminate aged right nasal bone and left lamina papyracea/medial orbital wall fractures. 3. No acute intracranial abnormality.
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FINDINGS: BRAIN PARENCHYMA: There is no acute intracranial hemorrhage or acute infarct. No brain edema or mass effect. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Left globe rupture with few foci of intraconal gas in the left orbit as as well as left periorbital contusion?. SINUSES: Mild maxillary sinus mucosal disease. MAXILLOFACIAL: Indeterminate aged right nasal bone fracture. Additional fracture of the left lamina papyracea/medial orbital wall with small amount of extraconal fat herniating through the fracture defect. Periapical lucency involving right maxillary premolar tooth.
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Findings: Brain parenchyma: Mild diffuse age-appropriate brain parenchymal volume loss is again seen. Scattered periventricular and subcortical white matter hypoattenuation is unchanged, suggestive of mild chronic microvascular ischemic disease. Stable left temporoparietal encephalomalacia, suggestive of remote infarct. The white-gray matter differentiation is preserved. Bilateral physiologic basal ganglia calcifications are again seen. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Persistent dense atherosclerotic calcifications of the bilateral carotid siphons. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Unchanged bilateral lens replacements. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Progressive opacification of the right greater than left ethmoid air cells, right sphenoid and right frontal sinuses, with mild left sphenoid and right maxillary sinus mucosal thickening.
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2,734
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: 70-year-old female with follow-up of abscess. COMPARISON: CT abdomen and pelvis 11/29/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 415 mm. DLP: 1059.30 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Interval resolution of bilateral pleural effusions. Mild bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery calcifications. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Mild fatty atrophy. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There has been interval removal of the percutaneous drain in the well-defined left perinephric collection. There is persistent gas and hyperdense foci throughout the collection with surrounding mesenteric fat stranding. The collection is unchanged in size measuring 8.2 x 8.1 cm (series 201 image 83), previously 8.1 x 7.9 cm as measured by me. The right atrophic kidney is unchanged. There is a transplanted kidney in the right lower quadrant with mild perinephric stranding, unchanged. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Persistent colonic wall thickening in the region of the descending and sigmoid colon. PERITONEUM / MESENTERY: Trace pelvic free fluid. RETROPERITONEUM: Retroperitoneal stranding is decreased compared to prior. VESSELS: Severe atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Interval improvement in the anasarca of the abdominal wall. Unchanged right lower quadrant scar. MUSCULOSKELETAL: Advanced discogenic degenerative changes of the lumbar spine most pronounced at L3-L4 and L4-L5. There is grade 1 anterolisthesis of L3 on L4 and L4 on L5. CONCLUSION: 1. Persistent air and inflammatory changes within the left perinephric region, concerning for persistent emphysematous pyelonephritis. 2. Persistent colonic wall thickening in the sigmoid and descending colon. Although perhaps reflecting focal colitis, given proximity to the left retroperitoneal/perinephric inflammatory changes this may be reactive. 3. Interval resolution of the bilateral pleural effusions. Decreased anasarca. 4. Additional chronic and incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Interval resolution of bilateral pleural effusions. Mild bibasilar atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary artery calcifications. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: Surgically absent. PANCREAS: Mild fatty atrophy. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There has been interval removal of the percutaneous drain in the well-defined left perinephric collection. There is persistent gas and hyperdense foci throughout the collection with surrounding mesenteric fat stranding. The collection is unchanged in size measuring 8.2 x 8.1 cm (series 201 image 83), previously 8.1 x 7.9 cm as measured by me. The right atrophic kidney is unchanged. There is a transplanted kidney in the right lower quadrant with mild perinephric stranding, unchanged. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Persistent colonic wall thickening in the region of the descending and sigmoid colon. PERITONEUM / MESENTERY: Trace pelvic free fluid. RETROPERITONEUM: Retroperitoneal stranding is decreased compared to prior. VESSELS: Severe atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Interval improvement in the anasarca of the abdominal wall. Unchanged right lower quadrant scar. MUSCULOSKELETAL: Advanced discogenic degenerative changes of the lumbar spine most pronounced at L3-L4 and L4-L5. There is grade 1 anterolisthesis of L3 on L4 and L4 on L5.
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FINDINGS: No acute fracture or dislocation. Along the medial aspect of the mid tibial diaphysis, there is a soft tissue mass measuring 1.1 x 0.8 x 1.9 cm (image 457, series 201; image 71, series 203) with associated cortical remodeling. The mass demonstrates mild homogeneous postcontrast enhancement. Additionally, there is a prominent vessel along the inferior aspect of the lesion. When compared to the knee radiographs dated 7/8/2020, the lesion is unchanged. The lesion is also partially imaged on knee radiographs dated 1/4/2018 Os navicularis. The joint spaces are maintained. No large hematoma or fluid collection. The soft tissues otherwise unremarkable.
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2,735
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EXAM: CT Angio Chest wo+w contrast CLINICAL INFORMATION: 20-year-old male with confirmed COVID pneumonia. Dyspnea. COMPARISON: None. TECHNIQUE: CT Angio Chest wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 447 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4.40 ml per sec. Scan delay: bolus tracked Scan field of view: 384 mm. KVP: 120 DLP: 773 mGy cm. FINDINGS: OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Bilateral groundglass opacities and nodular consolidations. Dependent atelectasis. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Hilar lymphadenopathy and prominent mediastinal lymph nodes are likely reactive. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Chronic healed left rib deformities. CONCLUSION: 1. No pulmonary embolism within limitation of slightly suboptimal contrast bolus. 2. Multifocal viral pneumonia. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: OVERALL DIAGNOSTIC QUALITY: Moderately suboptimal quality with incomplete evaluation of segmental and subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Bilateral groundglass opacities and nodular consolidations. Dependent atelectasis. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Hilar lymphadenopathy and prominent mediastinal lymph nodes are likely reactive. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: Chronic healed left rib deformities.
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Findings: Brain parenchyma: Mild age-appropriate frontal brain parenchymal volume loss is seen. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. Ventricular system: Normal configuration. No hydrocephalus. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Trace atherosclerotic calcifications of the bilateral carotid siphons. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. Mild dependent bilateral mastoid effusions. Paranasal sinuses: Well aerated.
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2,736
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CT Perfusion 1/6/2022 2:26 PM Clinical Information: cf stroke Comparison: No prior perfusion studies are available for comparison. Technique: A CT perfusion study was performed during single pass of 50 cc contrast bolus. Axial images were acquired at 8 axial locations and time-attenuation curves generated from this dataset were utilized to calculate cerebral blood flow, mean transit time, time to peak, and cerebral blood volume maps as well as region of interest specific quantitative data. "Prognostic" color maps were also generated using RAPID processing software Patient weight: 142 lbs. IV contrast: Omnipaque 350, 40 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 4 ml per sec. Scan delay: 0 sec. Scan field of view: 220 mm. DLP: 4341 mGy cm. Findings: The noncontrast images demonstrate postsurgical changes from left frontal extra-axial mass resection with expected postsurgical extra-axial hemorrhage and scant hemorrhage at the resection bed as well as adjacent sylvian subarachnoid hemorrhage. There is left frontal pneumocephalus. Adjacent left frontal edema is unchanged. Postcontrast images demonstrate no suspicious abnormal enhancement. RAPID images demonstrate CBF less than 30% volume: 10 ml and T Max greater than 6 seconds volume: 9 ml . Mismatch volume is -1 ml. There is no abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries. Conclusion: 1. Postsurgical changes from left frontal convexity meningioma resection. Small perfusion defect matching the resection bed. 2. No evidence of significant ischemia or infarction at the major intracranial arteries territories. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: The noncontrast images demonstrate postsurgical changes from left frontal extra-axial mass resection with expected postsurgical extra-axial hemorrhage and scant hemorrhage at the resection bed as well as adjacent sylvian subarachnoid hemorrhage. There is left frontal pneumocephalus. Adjacent left frontal edema is unchanged. Postcontrast images demonstrate no suspicious abnormal enhancement. RAPID images demonstrate CBF less than 30% volume: 10 ml and T Max greater than 6 seconds volume: 9 ml . Mismatch volume is -1 ml. There is no abnormal MTT, T max, CBV and CBF to suggest significant ischemia or infarction at the territory of the major intracranial arteries.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Similar appearance of dense pulmonary scarring and interlobular septal thickening most pronounced in the anterior aspects of the upper and midlungs. There is associated volume loss and traction bronchiectasis. There is no pleural effusion, or pneumothorax. With expiration, there is moderate to marked mosaic attenuation most pronounced in the lung bases. There is no tracheomalacia. Central airways are patent. HEART / VESSELS: There is mild atherosclerotic disease of the thoracic aorta. Heart size is normal. There is mild dilatation of the pulmonary artery trunk measuring 3.0 cm on series 3 image 61. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal noncontrast appearance of the imaged upper abdomen. Partially visualized anterior abdominal wall nodularity may be related to prior injections. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Degenerative changes in spine.
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2,737
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EXAM: CT Tib Fib Left wo contrast CLINICAL INFORMATION: History of Hodgkin lymphoma. COMPARISON: None. TECHNIQUE: CT Tib Fib Left wo contrast Scan field of view: 190 mm. DLP: 186 mGy cm. FINDINGS: BONES/JOINTS: No acute fracture or malalignment. Mild degenerative changes within the knee and ankle joints. There is osseous excrescence arising from the posterior proximal tibial metaphysis with medullary continuity, favored to represent an osteochondroma. SOFT TISSUES: Hyperattenuating fluid collection within the proximal medial head of the gastrocnemius measuring approximately 6.6 x 2.6 x 12.0 cm. No subcutaneous emphysema or foreign bodies. Diffuse subcutaneous edema of the foreleg. CONCLUSION: 1. Hematoma within the soft tissues of the medial gastrocnemius. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BONES/JOINTS: No acute fracture or malalignment. Mild degenerative changes within the knee and ankle joints. There is osseous excrescence arising from the posterior proximal tibial metaphysis with medullary continuity, favored to represent an osteochondroma. SOFT TISSUES: Hyperattenuating fluid collection within the proximal medial head of the gastrocnemius measuring approximately 6.6 x 2.6 x 12.0 cm. No subcutaneous emphysema or foreign bodies. Diffuse subcutaneous edema of the foreleg.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Interval resolution of immediate postsurgical changes pneumocephalus. Substantial interval decrease in size right cerebral convexity subdural hemorrhage which now measures 8 mm in maximum thickness with contents hypoattenuating to the adjacent brain parenchyma (previously 10 mm). Significant improvement in the mass effect with mild residual effacement of the right-sided cortical sulci. No midline shift (previously 4 mm). SKULL AND SKULL BASE: Right frontoparietotemporal craniotomy flap, unchanged. VENTRICULAR SYSTEM: Mass effect on the right lateral ventricle has resolved. ORBITS: Normal. IMAGED SINUSES: The paranasal sinuses and mastoid air cells are clear. SOFT TISSUES: Evolving right craniotomy postsurgical changes.
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2,738
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EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 61-year-old female with shortness of breath, pulmonary arterial hypertension. COMPARISON: PA and lateral chest radiograph dated 9/16/2021.. TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 280 mm. DLP: 242.01 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in supine position. FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent, with small volume secretions extending into the distal trachea into the proximal right main bronchus. Mild mixed emphysema, with minimal lower lobe bronchiectasis. There are ill-defined centrilobular nodules, with a few calcified pulmonary nodules. Bibasilar atelectasis/scarring in the lingula with a few scattered nodular opacities in the left upper lobe, with more confluent opacities in the left lower lobe. No reticulations in the lung bases. No honeycombing. No pleural effusion. No true expiratory mages are available. HEART / VESSELS: Left ventricle and biatrial enlargement. Three-vessel coronary artery calcifications. Thoracic aorta is normal in caliber. Pulmonary artery is mildly enlarged and measures up to 3.1 cm. Prosthetic mitral valve is noted. MEDIASTINUM / ESOPHAGUS: Moderate sized hiatal hernia. LYMPH NODES: Enlarged mediastinal lymph nodes, with partially calcified hilar and subcarinal lymph nodes. A representative 2.0 x 1.8 cm paratracheal lymph node on the right on axial image 86; series 2. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Nonobstructive renal calculi. Hepatic and splenic granuloma. MUSCULOSKELETAL: No destructive osseous lesion. Intact sternotomy CONCLUSION: 1. Scattered nodular opacities, with asymmetric involvement of the left lung with confluent airspace opacities in the left lower lobe, could be related to infectious/inflammatory process like pneumonia. However, given ill-defined centrilobular nodules, a few scattered calcified pulmonary nodules, with enlarged mediastinal and hilar lymph nodes, could be related to pulmonary sarcoidosis with secondary pulmonary arterial hypertension. 2. Enlarged pulmonary artery related to pulmonary arterial hypertension. 3. Enlarged left ventricle and biatrial enlargement. 4. Moderate sized hiatal hernia.
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FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent, with small volume secretions extending into the distal trachea into the proximal right main bronchus. Mild mixed emphysema, with minimal lower lobe bronchiectasis. There are ill-defined centrilobular nodules, with a few calcified pulmonary nodules. Bibasilar atelectasis/scarring in the lingula with a few scattered nodular opacities in the left upper lobe, with more confluent opacities in the left lower lobe. No reticulations in the lung bases. No honeycombing. No pleural effusion. No true expiratory mages are available. HEART / VESSELS: Left ventricle and biatrial enlargement. Three-vessel coronary artery calcifications. Thoracic aorta is normal in caliber. Pulmonary artery is mildly enlarged and measures up to 3.1 cm. Prosthetic mitral valve is noted. MEDIASTINUM / ESOPHAGUS: Moderate sized hiatal hernia. LYMPH NODES: Enlarged mediastinal lymph nodes, with partially calcified hilar and subcarinal lymph nodes. A representative 2.0 x 1.8 cm paratracheal lymph node on the right on axial image 86; series 2. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Nonobstructive renal calculi. Hepatic and splenic granuloma. MUSCULOSKELETAL: No destructive osseous lesion. Intact sternotomy
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FINDINGS: STRUCTURED REPORT: CTA Abdomen Pelvis VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No significant abnormality. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: Duplicated right renal arteries. There is approximately 50% stenosis of the proximal portion of the more superior renal artery. LEFT RENAL: Duplicated left renal arteries. IMA: No significant abnormality. RIGHT ILIAC / PROXIMAL FEMORAL ARTERIES: No significant abnormality. LEFT ILIAC / PROXIMAL FEMORAL ARTERIES: Mild calcified atherosclerotic disease of the distal common iliac artery. ------------------------------------------------------------- LOWER CHEST: LUNG BASES / PLEURA: Moderate bilateral pleural effusions with associated atelectasis. DISTAL ESOPHAGUS: Unremarkable. HEART / VESSELS: Moderate to large pericardial effusion. There is cardiomegaly. ABDOMEN and PELVIS: LIVER: No suspicious lesion identified. BILIARY TRACT: Mild intra and extrahepatic central biliary dilation. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: The spleen is enlarged measuring 14.7 cm in craniocaudal dimension. ADRENALS: The right adrenal gland appears normal. There is nodular thickening of the left adrenal gland. KIDNEYS: No hydronephrosis or suspicious mass. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: The stomach appears unremarkable. The loops of small bowel are normal in caliber. COLON / APPENDIX: There are postoperative changes of the right colon. The appendix is not visualized. PERITONEUM / MESENTERY: There is small free fluid in the pelvis. No free air. RETROPERITONEUM: Normal. OTHER VESSELS: There is a left common femoral venous catheter in place. URINARY BLADDER: There is irregular thickening of the urinary bladder. REPRODUCTIVE ORGANS: Unremarkable. BODY WALL: Unremarkable. MUSCULOSKELETAL: Degenerative changes of the spine.
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2,739
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CT Chest wo+w contrast Clinical Information: 45-year-old female fractured IVF filter per dr terry, Z95.828 Presence of other vascular implants and grafts Comparison: Previous chest CT dated 4/10/2011 and abdomen CT from 1//2022. Technique: Initial 3 mm thick noncontrast images were obtained through the thorax. Following injection of non-ionic contrast additional 3 mm images were obtained through the chest and upper abdomen. Patient weight: 176 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 35 sec. Scan field of view: 370 mm. DLP: 552 mGy cm. Findings: On the noncontrast exam a linear density projects near the confluence of the left inferior and superior pulmonary veins on series 3 images 49-55. This is best appreciated on sagittal series 6 image 56. On the postcontrast 1 mm thick images this is projects adjacent to but outside the confluence of the left pulmonary veins. [Series 11 images 149-164.. No focal fluid collection is seen around this density to indicate that it has pierced the left atrial wall. Other than the sternotomy wires no additional evidence of metal wire in the thorax. Borderline enlarged lower right paratracheal node measures 11 x 13 mm on series 11 image 113. Right hilar node is also enlarged measuring 13 mm in short axis on image 131. No additional enlarged intrathoracic nodes are present. Small amount of pericardial fluid is seen inferiorly. Small hiatal hernia is noted. The main pulmonary artery is again noted to be mildly enlarged at 37 mm similar to the 2011 exam. The heart size and mediastinum are otherwise normal. Small left pleural effusion is seen but decreased from yesterday's exam. Density of the fluid is predominantly less than 20 Hounsfield units consistent with bland fluid. Slight residual adjacent left lower lobe atelectasis is noted. Mild biapical pleural parenchymal scarring is similar to the prior. A 5 mm RML nodule on series 4 image 57 is unchanged from 2011 as is the peripheral RML nodule on image 60. Calcified granulomas also seen in the RML.. Tiny nodule along the right minor fissure is also unchanged as are peripheral RLL nodules on images 62 and 68. The lungs are otherwise normal. Limited images the upper abdomen end above the level of the known fractured IVC filter with only a small portion of the wire adjacent to the pancreatic head is seen. Small fluid collection anterior to the lateral left lobe of the liver is redemonstrated. The visualized upper abdomen is otherwise unremarkable.. Previous sternotomy. No focal destructive osseous lesions identified. Impression: 1. Density consistent with a piece of wire projects adjacent to but anterior and outside of the left pulmonary vein confluence. No adjacent fluid collection seen. Small pericardial effusion is seen. 2. Interval decrease in left pleural effusion and left basilar atelectasis. 3. RML calcified granuloma. Additional scattered noncalcified nodules which are unchanged back to 2011 and benign. 4. Enlarged main pulmonary artery concerning for pulmonary arterial hypertension. A few mildly enlarged mediastinal and hilar nodes.. Report called to nurse practitioner Mary King at1636 hours on 1/6 by Dr. Terry.
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Findings: On the noncontrast exam a linear density projects near the confluence of the left inferior and superior pulmonary veins on series 3 images 49-55. This is best appreciated on sagittal series 6 image 56. On the postcontrast 1 mm thick images this is projects adjacent to but outside the confluence of the left pulmonary veins. [Series 11 images 149-164.. No focal fluid collection is seen around this density to indicate that it has pierced the left atrial wall. Other than the sternotomy wires no additional evidence of metal wire in the thorax. Borderline enlarged lower right paratracheal node measures 11 x 13 mm on series 11 image 113. Right hilar node is also enlarged measuring 13 mm in short axis on image 131. No additional enlarged intrathoracic nodes are present. Small amount of pericardial fluid is seen inferiorly. Small hiatal hernia is noted. The main pulmonary artery is again noted to be mildly enlarged at 37 mm similar to the 2011 exam. The heart size and mediastinum are otherwise normal. Small left pleural effusion is seen but decreased from yesterday's exam. Density of the fluid is predominantly less than 20 Hounsfield units consistent with bland fluid. Slight residual adjacent left lower lobe atelectasis is noted. Mild biapical pleural parenchymal scarring is similar to the prior. A 5 mm RML nodule on series 4 image 57 is unchanged from 2011 as is the peripheral RML nodule on image 60. Calcified granulomas also seen in the RML.. Tiny nodule along the right minor fissure is also unchanged as are peripheral RLL nodules on images 62 and 68. The lungs are otherwise normal. Limited images the upper abdomen end above the level of the known fractured IVC filter with only a small portion of the wire adjacent to the pancreatic head is seen. Small fluid collection anterior to the lateral left lobe of the liver is redemonstrated. The visualized upper abdomen is otherwise unremarkable.. Previous sternotomy. No focal destructive osseous lesions identified.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multiple bilateral nonobstructing stones, of which the largest measures 6 mm. (Series 201, image 112). No perinephric stranding or hydroureteronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. Appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Multiple pelvic calcified phleboliths. URINARY BLADDER: Partially collapsed. Previously seen calcification near the urinary bladder is no longer seen. REPRODUCTIVE ORGANS: Supracervical hysterectomy. Ovaries are unremarkable. Previously noted right ovarian cyst is no longer visualized. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: No destructive osseous lesion.
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2,740
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CT Angio Neck, CT Angio Head. Contrast 1/6/2022 2:28 PM Clinical Information: Headaches, EDS Type 4, G43.909 Migraine, unspecified, not intractable, without status migrainosus, Q79.60 Ehlers-Danlos syndrome, unspecified Comparison: None Technique: 1.4 mm axial images were obtained during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the circle of Willis. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated. Patient weight: 128 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 225 mm. (accession CT220003266), Patient weight: 128 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 225 mm. DLP: 3907 mGy cm. (accession CT220003265) Findings: Noncontrast head CT: There is no intracranial hemorrhage. There are coarse calcifications within the right periventricular region extending into the basal ganglia. The right cerebral white matter shows slightly more advanced microangiopathic changes and some volume loss. There is asymmetric ex vacuo ventriculomegaly with a more pronounced right lateral ventricle. No acute orbital abnormality. No aggressive osseous lesion. Paranasal sinuses and mastoid cells are clear. There are prior postsurgical changes within the paranasal sinuses. Multinodular thyroid goiter. CT Angiography: There are two prominent draining veins within the right basal ganglia which drain into the sphenoparietal sinus and superiorly into the ependymal veins at the margin of the right lateral ventricle. This can be best seen on sagittal midline images (series 606 image 107-109). No definite arterial feeder is seen. Aortic arch: There is normal great vessel origin anatomy. There are no great vessel origin stenosis. Right carotid: Mild multifocal luminal irregularity. There is no evidence of flow-limiting cervical or intracranial right carotid stenoses. There is mild short segment dilatation of the distal right cervical ICA prior to entering the skull base. Left carotid: Moderate atherosclerotic disease of the carotid bulb without flow-limiting stenosis. There is an a partial dissection with a pseudoaneurysm at the midportion of cervical internal carotid (series 609 image 175) measuring approximately 8 mm in width and 18 mm in length (series 609 image 175). Right vertebral artery: There are no flow-limiting cervical or intracranial right vertebral artery stenoses. Left vertebral artery: No cervical or intracranial left vertebral artery stenoses are evident. Intracranial vessels: There are mild atherosclerotic calcifications of the carotid siphons without flow-limiting stenosis. There is mild luminal irregularity of the left greater than right posterior cerebral arteries with mild stenosis. Minimal luminal irregularity of the MCAs is also noted. Otherwise the remaining vertebral basilar system, the intracranial ICAs, MCAs and ACAs appear unremarkable. Conclusion: 1. Large right basal ganglia draining veins extending into the sphenoparietal sinus and ependymal region, likely a developmental venous anomaly. Adjacent asymmetric basal ganglia calcifications and encephalomalacia are also seen. 2. Left cervical internal carotid aneurysmal partial dissection with an 8 mm diameter pseudoaneurysm. 3. Additional scattered multifocal areas of luminal irregularity, mild dilatation and superimposed atherosclerotic changes without flow-limiting stenosis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Noncontrast head CT: There is no intracranial hemorrhage. There are coarse calcifications within the right periventricular region extending into the basal ganglia. The right cerebral white matter shows slightly more advanced microangiopathic changes and some volume loss. There is asymmetric ex vacuo ventriculomegaly with a more pronounced right lateral ventricle. No acute orbital abnormality. No aggressive osseous lesion. Paranasal sinuses and mastoid cells are clear. There are prior postsurgical changes within the paranasal sinuses. Multinodular thyroid goiter. CT Angiography: There are two prominent draining veins within the right basal ganglia which drain into the sphenoparietal sinus and superiorly into the ependymal veins at the margin of the right lateral ventricle. This can be best seen on sagittal midline images (series 606 image 107-109). No definite arterial feeder is seen. Aortic arch: There is normal great vessel origin anatomy. There are no great vessel origin stenosis. Right carotid: Mild multifocal luminal irregularity. There is no evidence of flow-limiting cervical or intracranial right carotid stenoses. There is mild short segment dilatation of the distal right cervical ICA prior to entering the skull base. Left carotid: Moderate atherosclerotic disease of the carotid bulb without flow-limiting stenosis. There is an a partial dissection with a pseudoaneurysm at the midportion of cervical internal carotid (series 609 image 175) measuring approximately 8 mm in width and 18 mm in length (series 609 image 175). Right vertebral artery: There are no flow-limiting cervical or intracranial right vertebral artery stenoses. Left vertebral artery: No cervical or intracranial left vertebral artery stenoses are evident. Intracranial vessels: There are mild atherosclerotic calcifications of the carotid siphons without flow-limiting stenosis. There is mild luminal irregularity of the left greater than right posterior cerebral arteries with mild stenosis. Minimal luminal irregularity of the MCAs is also noted. Otherwise the remaining vertebral basilar system, the intracranial ICAs, MCAs and ACAs appear unremarkable.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: A 3 cm cyst noted in the right hepatic lobe. Additional hypoattenuating lesions are too small to characterize. BILIARY TRACT: Normal. GALLBLADDER: Contracted. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Mass-like thickening along the posterior gastric wall, near the fundus. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. L-SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Discogenic degenerative changes and spondylosis. At L4-L5 with disc bulge with superimposed right paracentral protrusion causing moderate spinal canal and bilateral neural foraminal narrowing, left greater than right. Shallow disc bulge at L5-S1 mildly narrows the left spinal canal and left neural foramen. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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2,741
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CT Angio Neck, CT Angio Head. Contrast 1/6/2022 2:28 PM Clinical Information: Headaches, EDS Type 4, G43.909 Migraine, unspecified, not intractable, without status migrainosus, Q79.60 Ehlers-Danlos syndrome, unspecified Comparison: None Technique: 1.4 mm axial images were obtained during the early arterial phase of a rapid IV infusion of contrast, from the thoracic inlet through the circle of Willis. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated. Patient weight: 128 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 225 mm. (accession CT220003266), Patient weight: 128 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. IV contrast injection rate: 4 ml per sec. Scan delay: bt sec. Scan field of view: 225 mm. DLP: 3907 mGy cm. (accession CT220003265) Findings: Noncontrast head CT: There is no intracranial hemorrhage. There are coarse calcifications within the right periventricular region extending into the basal ganglia. The right cerebral white matter shows slightly more advanced microangiopathic changes and some volume loss. There is asymmetric ex vacuo ventriculomegaly with a more pronounced right lateral ventricle. No acute orbital abnormality. No aggressive osseous lesion. Paranasal sinuses and mastoid cells are clear. There are prior postsurgical changes within the paranasal sinuses. Multinodular thyroid goiter. CT Angiography: There are two prominent draining veins within the right basal ganglia which drain into the sphenoparietal sinus and superiorly into the ependymal veins at the margin of the right lateral ventricle. This can be best seen on sagittal midline images (series 606 image 107-109). No definite arterial feeder is seen. Aortic arch: There is normal great vessel origin anatomy. There are no great vessel origin stenosis. Right carotid: Mild multifocal luminal irregularity. There is no evidence of flow-limiting cervical or intracranial right carotid stenoses. There is mild short segment dilatation of the distal right cervical ICA prior to entering the skull base. Left carotid: Moderate atherosclerotic disease of the carotid bulb without flow-limiting stenosis. There is an a partial dissection with a pseudoaneurysm at the midportion of cervical internal carotid (series 609 image 175) measuring approximately 8 mm in width and 18 mm in length (series 609 image 175). Right vertebral artery: There are no flow-limiting cervical or intracranial right vertebral artery stenoses. Left vertebral artery: No cervical or intracranial left vertebral artery stenoses are evident. Intracranial vessels: There are mild atherosclerotic calcifications of the carotid siphons without flow-limiting stenosis. There is mild luminal irregularity of the left greater than right posterior cerebral arteries with mild stenosis. Minimal luminal irregularity of the MCAs is also noted. Otherwise the remaining vertebral basilar system, the intracranial ICAs, MCAs and ACAs appear unremarkable. Conclusion: 1. Large right basal ganglia draining veins extending into the sphenoparietal sinus and ependymal region, likely a developmental venous anomaly. Adjacent asymmetric basal ganglia calcifications and encephalomalacia are also seen. 2. Left cervical internal carotid aneurysmal partial dissection with an 8 mm diameter pseudoaneurysm. 3. Additional scattered multifocal areas of luminal irregularity, mild dilatation and superimposed atherosclerotic changes without flow-limiting stenosis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Noncontrast head CT: There is no intracranial hemorrhage. There are coarse calcifications within the right periventricular region extending into the basal ganglia. The right cerebral white matter shows slightly more advanced microangiopathic changes and some volume loss. There is asymmetric ex vacuo ventriculomegaly with a more pronounced right lateral ventricle. No acute orbital abnormality. No aggressive osseous lesion. Paranasal sinuses and mastoid cells are clear. There are prior postsurgical changes within the paranasal sinuses. Multinodular thyroid goiter. CT Angiography: There are two prominent draining veins within the right basal ganglia which drain into the sphenoparietal sinus and superiorly into the ependymal veins at the margin of the right lateral ventricle. This can be best seen on sagittal midline images (series 606 image 107-109). No definite arterial feeder is seen. Aortic arch: There is normal great vessel origin anatomy. There are no great vessel origin stenosis. Right carotid: Mild multifocal luminal irregularity. There is no evidence of flow-limiting cervical or intracranial right carotid stenoses. There is mild short segment dilatation of the distal right cervical ICA prior to entering the skull base. Left carotid: Moderate atherosclerotic disease of the carotid bulb without flow-limiting stenosis. There is an a partial dissection with a pseudoaneurysm at the midportion of cervical internal carotid (series 609 image 175) measuring approximately 8 mm in width and 18 mm in length (series 609 image 175). Right vertebral artery: There are no flow-limiting cervical or intracranial right vertebral artery stenoses. Left vertebral artery: No cervical or intracranial left vertebral artery stenoses are evident. Intracranial vessels: There are mild atherosclerotic calcifications of the carotid siphons without flow-limiting stenosis. There is mild luminal irregularity of the left greater than right posterior cerebral arteries with mild stenosis. Minimal luminal irregularity of the MCAs is also noted. Otherwise the remaining vertebral basilar system, the intracranial ICAs, MCAs and ACAs appear unremarkable.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: A 3 cm cyst noted in the right hepatic lobe. Additional hypoattenuating lesions are too small to characterize. BILIARY TRACT: Normal. GALLBLADDER: Contracted. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Mass-like thickening along the posterior gastric wall, near the fundus. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. L-SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. Discogenic degenerative changes and spondylosis. At L4-L5 with disc bulge with superimposed right paracentral protrusion causing moderate spinal canal and bilateral neural foraminal narrowing, left greater than right. Shallow disc bulge at L5-S1 mildly narrows the left spinal canal and left neural foramen. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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2,742
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: Shortness of breath. History of metastatic neuroendocrine tumor. COMPARISON: CT chest 8/24/2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 410 mm. DLP: 212.81 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Left thyroid lobe nodule measures up to 1.6 cm. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Increased size of moderate right pleural effusion with adjacent atelectasis. Similar appearance of small left pleural effusion with pleural thickening. Adjacent left lower lobe round atelectasis is similar prior. Calcified granuloma is again seen in the left lower lobe. Nodular consolidation in the posterior lingula is increased in size and more prominent compared to prior measuring 1.9 x 1.5 cm (series 2, image 75). Small thin-walled cysts are again seen in the right middle and lower lobes, possibly pneumatoceles. HEART / VESSELS: The heart is normal in size. Mild coronary artery atherosclerotic calcifications. No pericardial effusion. Mild calcified atherosclerotic disease of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Punctate left breast calcification. UPPER ABDOMEN: Calcified granuloma in the liver. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel degenerative changes and diffuse idiopathic skeletal hyperostosis of the thoracic spine. CONCLUSION: 1. Increased size of moderate right pleural effusion with adjacent atelectasis. 2. Redemonstration of chronic left pleural effusion with pleural thickening and adjacent left lower lobe round atelectasis. 3. Increased size of nodular opacity in the posterior lingula. Recommend attention on follow-up. 4. Left thyroid lobe nodule. Recommend follow-up outpatient thyroid ultrasound. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Left thyroid lobe nodule measures up to 1.6 cm. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Increased size of moderate right pleural effusion with adjacent atelectasis. Similar appearance of small left pleural effusion with pleural thickening. Adjacent left lower lobe round atelectasis is similar prior. Calcified granuloma is again seen in the left lower lobe. Nodular consolidation in the posterior lingula is increased in size and more prominent compared to prior measuring 1.9 x 1.5 cm (series 2, image 75). Small thin-walled cysts are again seen in the right middle and lower lobes, possibly pneumatoceles. HEART / VESSELS: The heart is normal in size. Mild coronary artery atherosclerotic calcifications. No pericardial effusion. Mild calcified atherosclerotic disease of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: Punctate left breast calcification. UPPER ABDOMEN: Calcified granuloma in the liver. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel degenerative changes and diffuse idiopathic skeletal hyperostosis of the thoracic spine.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Mastoid air cells are clear. Pneumatization of the petrous apices is noted. VENTRICULAR SYSTEM: Normal. ORBITS: Globes are intact. Linear densities along the inferior aspect of the left orbit may be from prior procedure. SINUSES: Small mucous retention cysts in the right frontal and bilateral maxillary sinuses. Occasional ethmoid air cell opacities.
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2,743
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CT Head wo contrast 1/6/2022 3:36 PM Clinical Information: COVID Confirmed confusion Spec Inst: convalesced Comparison: Head CT 12/24/2021 Technique: Unenhanced axial brain CT with coronal and sagittal reconstructions. Scan field of view: 210 mm. DLP: 2571 mGy cm. Findings: There is mild diffuse cerebral volume loss with ventricular prominence. There is no acute hemorrhage, evidence of acute infarction or hydrocephalus. There is no vasogenic edema or mass effect. There is a partially empty sella. There is patchy mucosal thickening in the ethmoid air cells and right maxillary sinus. The remaining visualized paranasal sinuses and mastoid air cells are clear. Impression: 1. No CT evidence of acute intracranial abnormality.
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Findings: There is mild diffuse cerebral volume loss with ventricular prominence. There is no acute hemorrhage, evidence of acute infarction or hydrocephalus. There is no vasogenic edema or mass effect. There is a partially empty sella. There is patchy mucosal thickening in the ethmoid air cells and right maxillary sinus. The remaining visualized paranasal sinuses and mastoid air cells are clear.
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Findings: The visualized paranasal sinuses appear clear of acute process. Ostiomeatal complexes appear patent. The visualized osseous structures appear intact. The remaining visualized osseous and soft tissue structures appear within normal limits. Evaluation for soft tissue abnormalities is limited on this non contrast scan. No definite mass identified. -
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2,744
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EXAM: CT Abdomen and Pelvis wo+w contrast CLINICAL INFORMATION: Congenital heart disease. Concern for cirrhosis. COMPARISON: 9/10/2020 TECHNIQUE: CT Abdomen and Pelvis wo+w contrast. Patient weight: 167 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt/80 sec. Scan field of view: 433 mm. DLP: 1237 mGy cm. FINDINGS: STRUCTURED REPORT: CT HCC Screening FINDINGS: IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Mild mosaicism at the lung bases. HEART / VESSELS: Known complex congenital heart disease. Partially imaged IVC conduit. ABDOMEN: LIVER: Cirrhotic. No steatosis. There are diffuse congestive changes throughout the liver parenchyma. The enhancement is nearly isoattenuating by the delayed phase. No definite arterial enhancing lesion is visualized. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent but enlarged right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: No enlarged periportal nodes. There are multiple prominent and mildly enlarged mesenteric nodes, minimally increased from prior. SPLEEN: Splenomegaly. PERITONEUM / ASCITES: Trace ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Minimally nodular glands bilaterally. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Mild thickening. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No new destructive lesions. CONCLUSION: 1. Cirrhotic liver with changes from diffuse congestive changes again seen without suspicious hepatic lesion. 2. Multiple mildly enlarged and prominent mesenteric lymph nodes are slightly increased compared to prior exam. This is of unclear significance. Other incidental and noncontributory findings as described above.
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FINDINGS: STRUCTURED REPORT: CT HCC Screening FINDINGS: IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Mild mosaicism at the lung bases. HEART / VESSELS: Known complex congenital heart disease. Partially imaged IVC conduit. ABDOMEN: LIVER: Cirrhotic. No steatosis. There are diffuse congestive changes throughout the liver parenchyma. The enhancement is nearly isoattenuating by the delayed phase. No definite arterial enhancing lesion is visualized. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Patent with conventional anatomy. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent but enlarged right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: None. LIVER RELATED FINDINGS: BILIARY DUCTS: No biliary dilatation. GALLBLADDER: No abnormality. LYMPH NODES: No enlarged periportal nodes. There are multiple prominent and mildly enlarged mesenteric nodes, minimally increased from prior. SPLEEN: Splenomegaly. PERITONEUM / ASCITES: Trace ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Minimally nodular glands bilaterally. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. URINARY BLADDER: Mild thickening. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No new destructive lesions.
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FINDINGS: The pulmonary artery opacification is excellent and well opacified pulmonary arteries and its branches demonstrate no intraluminal filling defect. Interval increase in the multiloculated left pleural effusion with few areas of nodular pleural thickening and small air along the upper costal collection with significant near complete left lower lobe and partial left upper lobe atelectasis. Right lung is clear. A small right-sided pleural effusion is also noted along with pericardial effusion. A lobular partly enhancing soft tissue mass in the anterior mediastinum measures approximately 12.6 x 6.2 cm in axial image 50, series 201. Few additional small nodes are present in the paratracheal and subcarinal region. There is no focal lytic or sclerotic bone lesion. Multiple collaterals are seen in the left chest wall and upper mediastinum due to narrowing in the left axillary, subclavian and left innominate vein. The right innominate and SVC are patent.
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2,745
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EXAM: CT Chest wo contrast, CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Organ donation evaluation. COMPARISON: None. TECHNIQUE: CT Chest wo contrast, CT Abdomen and Pelvis wo IV contrast. Scan field of view: 215 mm. DLP: 1126 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube terminates in the trachea above the carina in satisfactory position. A few tracheal secretions are present as well as a few secretions in the left mainstem bronchus. The lungs are clear. No effusion or pneumothorax evident. No suspicious lung nodule or lung mass evident. HEART / VESSELS: Moderate to severe coronary atherosclerotic calcification. Mild to moderate aortic root calcification. Heart size is normal. Scattered mild atherosclerotic calcification of the aorta. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube is present terminating in the gastric body. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: There is vicarious excretion of contrast into the gallbladder and cholelithiasis are suspected. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a persistent nephrogram likely related to recent CT angiogram neck with contrast. There is excretion of contrast into the ureters and bladder. No renal lesion or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the gastric body. There is gastric distention with fluid and gas. The stomach is nondilated. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate to severe atherosclerotic calcification in the aorta and iliac territories. URINARY BLADDER: Foley catheter is present. There is contrast partially distending the bladder. REPRODUCTIVE ORGANS: A few dystrophic calcifications in the prostate and penile calcifications. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is osteonecrosis in the right femoral head. Multilevel degenerative changes are present in the thoracic and lumbar spine along with diffuse interosseous skeletal hyperostosis. No acute osseous abnormality evident. Chronic appearing mild wedging of T8 and T9. Scattered Schmorl's nodes. CONCLUSION: 1. No acute abnormality or mass evident in the chest. Endotracheal tube projects in satisfactory position and a few airway secretions are present. 2. Atherosclerotic coronary and aortic disease. 3. Gastric distention with air and fluid which could be neurogenic in etiology. 4. Cholelithiasis. 5. Persistent nephrogram/contrast-enhanced appearance of the kidney and recommend renal function correlation. Additional and incidental findings, as above.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube terminates in the trachea above the carina in satisfactory position. A few tracheal secretions are present as well as a few secretions in the left mainstem bronchus. The lungs are clear. No effusion or pneumothorax evident. No suspicious lung nodule or lung mass evident. HEART / VESSELS: Moderate to severe coronary atherosclerotic calcification. Mild to moderate aortic root calcification. Heart size is normal. Scattered mild atherosclerotic calcification of the aorta. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube is present terminating in the gastric body. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: There is vicarious excretion of contrast into the gallbladder and cholelithiasis are suspected. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a persistent nephrogram likely related to recent CT angiogram neck with contrast. There is excretion of contrast into the ureters and bladder. No renal lesion or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the gastric body. There is gastric distention with fluid and gas. The stomach is nondilated. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate to severe atherosclerotic calcification in the aorta and iliac territories. URINARY BLADDER: Foley catheter is present. There is contrast partially distending the bladder. REPRODUCTIVE ORGANS: A few dystrophic calcifications in the prostate and penile calcifications. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is osteonecrosis in the right femoral head. Multilevel degenerative changes are present in the thoracic and lumbar spine along with diffuse interosseous skeletal hyperostosis. No acute osseous abnormality evident. Chronic appearing mild wedging of T8 and T9. Scattered Schmorl's nodes.
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FINDINGS: BRAIN PARENCHYMA: No intraparenchymal hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is appropriate for patient's age. EXTRA-AXIAL SPACES: No epidural, subdural, or subarachnoid hemorrhage. SKULL AND SKULL BASE: No acute fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Unremarkable SINUSES: Visualized mastoid air cells and paranasal sinuses are well aerated.
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2,746
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EXAM: CT Chest wo contrast, CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Organ donation evaluation. COMPARISON: None. TECHNIQUE: CT Chest wo contrast, CT Abdomen and Pelvis wo IV contrast. Scan field of view: 215 mm. DLP: 1126 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube terminates in the trachea above the carina in satisfactory position. A few tracheal secretions are present as well as a few secretions in the left mainstem bronchus. The lungs are clear. No effusion or pneumothorax evident. No suspicious lung nodule or lung mass evident. HEART / VESSELS: Moderate to severe coronary atherosclerotic calcification. Mild to moderate aortic root calcification. Heart size is normal. Scattered mild atherosclerotic calcification of the aorta. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube is present terminating in the gastric body. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: There is vicarious excretion of contrast into the gallbladder and cholelithiasis are suspected. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a persistent nephrogram likely related to recent CT angiogram neck with contrast. There is excretion of contrast into the ureters and bladder. No renal lesion or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the gastric body. There is gastric distention with fluid and gas. The stomach is nondilated. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate to severe atherosclerotic calcification in the aorta and iliac territories. URINARY BLADDER: Foley catheter is present. There is contrast partially distending the bladder. REPRODUCTIVE ORGANS: A few dystrophic calcifications in the prostate and penile calcifications. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is osteonecrosis in the right femoral head. Multilevel degenerative changes are present in the thoracic and lumbar spine along with diffuse interosseous skeletal hyperostosis. No acute osseous abnormality evident. Chronic appearing mild wedging of T8 and T9. Scattered Schmorl's nodes. CONCLUSION: 1. No acute abnormality or mass evident in the chest. Endotracheal tube projects in satisfactory position and a few airway secretions are present. 2. Atherosclerotic coronary and aortic disease. 3. Gastric distention with air and fluid which could be neurogenic in etiology. 4. Cholelithiasis. 5. Persistent nephrogram/contrast-enhanced appearance of the kidney and recommend renal function correlation. Additional and incidental findings, as above.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube terminates in the trachea above the carina in satisfactory position. A few tracheal secretions are present as well as a few secretions in the left mainstem bronchus. The lungs are clear. No effusion or pneumothorax evident. No suspicious lung nodule or lung mass evident. HEART / VESSELS: Moderate to severe coronary atherosclerotic calcification. Mild to moderate aortic root calcification. Heart size is normal. Scattered mild atherosclerotic calcification of the aorta. MEDIASTINUM / ESOPHAGUS: Esophagogastric tube is present terminating in the gastric body. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: There is vicarious excretion of contrast into the gallbladder and cholelithiasis are suspected. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: There is a persistent nephrogram likely related to recent CT angiogram neck with contrast. There is excretion of contrast into the ureters and bladder. No renal lesion or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Esophagogastric tube terminates in the gastric body. There is gastric distention with fluid and gas. The stomach is nondilated. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate to severe atherosclerotic calcification in the aorta and iliac territories. URINARY BLADDER: Foley catheter is present. There is contrast partially distending the bladder. REPRODUCTIVE ORGANS: A few dystrophic calcifications in the prostate and penile calcifications. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is osteonecrosis in the right femoral head. Multilevel degenerative changes are present in the thoracic and lumbar spine along with diffuse interosseous skeletal hyperostosis. No acute osseous abnormality evident. Chronic appearing mild wedging of T8 and T9. Scattered Schmorl's nodes.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis CT chest findings are reported separately. ABDOMEN and PELVIS: LIVER: Stable appearance of a subcentimeter hypodensity along the margin of the right hepatic lobe on axial series 2, image 247. No new hepatic lesion. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Simple left renal cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: Few scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Grossly unchanged size and appearance of the hazy nodule adjacent to the left lower quadrant peritoneum, currently measuring 7 mm on axial series 2, image 322. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Uterus is surgically absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multilevel endplate and facet changes are present.
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2,747
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EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: 77-year-old female with shortness of breath. Past history of severe peripheral arterial disease, with suspected aortitis and possible polymyalgia. Restrictive lung disease, rule out ILD. COMPARISON: Outside CT angiographic dated 10/17/2021. Multiple prior CT chest, most recently dated 721. Chest radiograph 12/27/2021. TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 350 mm. DLP: 424 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in prone position. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Heterogeneous attenuation of the thyroid gland with partially calcified nodule in the left thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: Mild volume loss in the right lung. There is diffuse peripheral reticulation in the right greater than left lung, greatest involving the dependent lower lobes. No extensive groundglass opacities or evidence of honeycombing. No significant bronchiectasis. Mild peribronchial thickening in the lower lobes. Nodular opacities in the right upper lobe has increased in size from prior exam measuring 16 x 12 mm (image 54, series #2), previously 14 x 10 mm (remeasured on prior exam), corresponds to arteriovenous malformation on prior CT angiographic dated 10/17/2021. Focal round nodule in the right middle lobe is stable in size measuring 9 mm x 7 mm (image 113, series #2) and can be dated back to 2016. Bilateral apical predominant centrilobular and paraseptal emphysematous changes. Scattered calcified granulomas. No pneumothorax or pleural effusion. Left hemidiaphragm elevation. Expiratory images demonstrate mild tracheal malacia and central bronchomalacia with diffuse air trapping. HEART / VESSELS: Left atrium and ventricle appears dilated. Small pericardial effusion. Advanced multivessel coronary artery atherosclerosis. Moderate atherosclerosis of the thoracic aorta and arch vessels. Mildly enlarged main pulmonary artery measuring 3.0 cm. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: Shotty and scattered enlarged mediastinal and perihilar lymph nodes are again seen, for example a right lower paratracheal lymph node measuring 2.0 x 1.0 cm (image 75, series #2), similar to prior exam. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Advanced atherosclerosis of the abdominal aorta and branch vessels. Punctate nonobstructing nephrolithiasis of the midportion left kidney. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the thoracic spine. CONCLUSION: 1. Mild subpleural reticulation in the lung bases, mild tracheobronchomalacia and diffuse air trapping. Features are suggestive of early interstitial lung disease, with a reactive airway disease/hypersensitivity. 2. Right upper lobe AV malformation, overall unchanged from prior CT angiogram chest. 3. Mildly dilated pulmonary artery, could be related to pulmonary arterial hypertension. Reactive mediastinal lymph nodes. 4. Small pericardial effusion and other incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Heterogeneous attenuation of the thyroid gland with partially calcified nodule in the left thyroid lobe. CHEST: LUNGS / AIRWAYS / PLEURA: Mild volume loss in the right lung. There is diffuse peripheral reticulation in the right greater than left lung, greatest involving the dependent lower lobes. No extensive groundglass opacities or evidence of honeycombing. No significant bronchiectasis. Mild peribronchial thickening in the lower lobes. Nodular opacities in the right upper lobe has increased in size from prior exam measuring 16 x 12 mm (image 54, series #2), previously 14 x 10 mm (remeasured on prior exam), corresponds to arteriovenous malformation on prior CT angiographic dated 10/17/2021. Focal round nodule in the right middle lobe is stable in size measuring 9 mm x 7 mm (image 113, series #2) and can be dated back to 2016. Bilateral apical predominant centrilobular and paraseptal emphysematous changes. Scattered calcified granulomas. No pneumothorax or pleural effusion. Left hemidiaphragm elevation. Expiratory images demonstrate mild tracheal malacia and central bronchomalacia with diffuse air trapping. HEART / VESSELS: Left atrium and ventricle appears dilated. Small pericardial effusion. Advanced multivessel coronary artery atherosclerosis. Moderate atherosclerosis of the thoracic aorta and arch vessels. Mildly enlarged main pulmonary artery measuring 3.0 cm. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: Shotty and scattered enlarged mediastinal and perihilar lymph nodes are again seen, for example a right lower paratracheal lymph node measuring 2.0 x 1.0 cm (image 75, series #2), similar to prior exam. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Advanced atherosclerosis of the abdominal aorta and branch vessels. Punctate nonobstructing nephrolithiasis of the midportion left kidney. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the thoracic spine.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Multiple hypoattenuating thyroid nodules, stable. CHEST: LUNGS / AIRWAYS / PLEURA: Stable appearance of 4 mm pulmonary nodules in the right lower lobe on series 2 image 121, 110. No new suspicious pulmonary nodule is identified. No focal consolidation, pleural effusion, or pneumothorax. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild atherosclerotic calcifications of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: None enlarged. CHEST WALL: Right chest wall Mediport is present, catheter tip terminates in the SVC. Nodular density in the right breast (series 2 image 45) with adjacent calcific focus is unchanged. UPPER ABDOMEN: Please see same day CT abdomen for abdomen findings. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Degenerative changes in spine.
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2,748
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CLINICAL HISTORY: Gun shot wound, Y24.9XXA Unspecified firearm discharge, undetermined intent, initial encounter Spec Inst: fu GSW to the head EXAM: CT Head wo contrast TECHNIQUE: 5 mm thick serial axial images were obtained throughout the head without intravenous contrast. Scan field of view: 223 mm. DLP: 836 mGy cm. COMPARISON: 11/22/2021 FINDINGS: Left frontal craniotomy changes are again noted. There is resolving soft tissue swelling and gas as well as small fluid collection within the overlying scalp soft tissues. There are scattered small metallic foreign bodies representing bullet fragments within the left facial and left scalp soft tissues without interval change. Intracranially there is encephalomalacia within the anterior left temporal lobe and also within the left frontal lobe. Tiny extra-axial fluid collection underlying the craniotomy defect has decreased in size. There is a single tiny metallic foreign body within the left frontal lobe without interval change. There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction. The ventricles are unremarkable. There is no mass effect. There is stable deformity of the left maxillary sinus which remains opacified. There is persistent defect of the floor of the left orbit with development of enophthalmos.. There is also mild buckling of the roof of the left orbit Fractures of the lateral wall of the left orbit and the left zygomatic arch appear unchanged. There is progressive opacification of the right maxillary sinus and right frontal sinus.. CONCLUSION: 01. Multiple facial fractures and left facial and left scalp soft tissue injuries are redemonstrated with multiple metallic bullet fragments. Previous fluid collection within the left frontal scalp and foci of gas have resolved. 02. There is chronic depressed fracture of the left orbital floor with development of mild left enophthalmos. 03. Stable left frontal lobe and left temporal lobe encephalomalacia. Stable single tiny metallic foreign body within the left frontal lobe. No acute intracranial abnormality
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FINDINGS: Left frontal craniotomy changes are again noted. There is resolving soft tissue swelling and gas as well as small fluid collection within the overlying scalp soft tissues. There are scattered small metallic foreign bodies representing bullet fragments within the left facial and left scalp soft tissues without interval change. Intracranially there is encephalomalacia within the anterior left temporal lobe and also within the left frontal lobe. Tiny extra-axial fluid collection underlying the craniotomy defect has decreased in size. There is a single tiny metallic foreign body within the left frontal lobe without interval change. There is no acute intracranial hemorrhage. There are no abnormal areas of hypoattenuation to suggest acute infarction. The ventricles are unremarkable. There is no mass effect. There is stable deformity of the left maxillary sinus which remains opacified. There is persistent defect of the floor of the left orbit with development of enophthalmos.. There is also mild buckling of the roof of the left orbit Fractures of the lateral wall of the left orbit and the left zygomatic arch appear unchanged. There is progressive opacification of the right maxillary sinus and right frontal sinus..
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Findings: Lines and Tubes: Right-sided port tip terminates in the lower right brachiocephalic vein. Near its entrance site into the right internal jugular vein there is nonocclusive thrombus. There is also likely nonocclusive thrombus in the right brachiocephalic vein just prior to its confluence with the left. Body Wall and Abdomen: No destructive osseous lesions. CT of the abdomen and pelvis will be reported separately. Lymph Nodes, Mediastinum and Neck: No axillary or mediastinal adenopathy. Lungs and Pleura: No pleural effusion. Mild bronchial wall thickening and mild airway secretions. Mild paraseptal emphysema. Tiny subpleural right upper lobe nodule image 49 is unchanged. Noncalcified right lower lobe nodule image 92 is unchanged. Small right upper lobe nodule image 41 has a linear appearance on coronally reformatted images noncalcified left lower lobe nodule image 94 is unchanged. Cardiovascular: No central PTE, large pericardial effusion. Heart size is normal.
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2,749
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EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: Follow-up bronchiectasis COMPARISON: CTs of the chest from 7/24/2021 and earlier. TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 396 mm. DLP: 246 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory technique in supine position. FINDINGS: Linear scarring or atelectasis again seen within the middle lobe and lingula with some associated minimal bronchiectasis. Other areas of minimal bronchiectasis with bronchial wall thickening bilaterally appear similar to the prior examination. Linear opacities within the bilateral lower lobes likely represent atelectasis. No consolidation. No new or enlarging nodules. No pleural effusion or pleural thickening. The supraclavicular region is unremarkable. The central airways are patent. The thoracic aorta is nonaneurysmal. The heart is not enlarged. No pericardial effusion. No enlarged thoracic lymph nodes. The esophagus is not dilated. No acute or aggressive osseous abnormality. CONCLUSION: Unchanged minimal chronic bronchiectasis and bronchial thickening with linear scarring or atelectasis within the middle lobe and lingula. No acute intrathoracic abnormality.
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FINDINGS: Linear scarring or atelectasis again seen within the middle lobe and lingula with some associated minimal bronchiectasis. Other areas of minimal bronchiectasis with bronchial wall thickening bilaterally appear similar to the prior examination. Linear opacities within the bilateral lower lobes likely represent atelectasis. No consolidation. No new or enlarging nodules. No pleural effusion or pleural thickening. The supraclavicular region is unremarkable. The central airways are patent. The thoracic aorta is nonaneurysmal. The heart is not enlarged. No pericardial effusion. No enlarged thoracic lymph nodes. The esophagus is not dilated. No acute or aggressive osseous abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Redemonstrated large central necrotic hepatic mass measuring about 9.6 x 9.0 cm (series 308, image 88), previously about similar size measuring 9.3 x 9.3 cm. The lateral right hepatic dome lesions are less prominent compared to prior CT. Again seen is tumor thrombosis of the middle hepatic vein and unchanged focal T1 protrusions in the left branch of portal vein. Anterior right branch of portal vein is occluded. No new hepatic lesions. Stable trace pericardial hepatic fluid. A new satellite 2.0 cm posterior left hepatic lobe segment 3 lesion. An additional small satellite lesion measuring 1.7 cm in the segment 4A (series 308, image 71). BILIARY TRACT: Stable mild peripheral intrahepatic duct dilatation, upstream to the large hepatic mass. Stable position of the internal biliary stents within the central hepatic ducts GALLBLADDER: Gallbladder is not seen separately from the mass. Radiopaque gallstone is again visualized. PANCREAS: Atrophic pancreas. Pancreatic duct is nondilated. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Nonspecific left renal calculus. Stable right renal cyst. No hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is partially distended with is abnormal dilatation of small bowel loops. COLON / APPENDIX: Moderate colonic stool burden. No abnormal large bowel distention. PERITONEUM / MESENTERY: Trace pelvic free fluid. No pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Mild aortic wall calcifications. Replaced left hepatic artery arises from the left gastric artery. Right upper quadrant mesenteric collaterals are seen. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Surgically absent prostate gland. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Multilevel degenerative changes in lumbar spine predominantly at L4-L5 and L5-S1. Lumbar vertebrae demonstrate normal height.
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2,750
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: History of prostate cancer COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 190 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 420 mm. DLP: 740.87 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal bibasilar subsegmental atelectasis. No suspicious nodule or mass identified. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No abnormality.. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral pelviectasis. No obstructing mass or stone visualized. Small left superior pole cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered diverticula without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate sized fat-containing umbilical hernia. MUSCULOSKELETAL: No acute or aggressive osseous abnormality, specifically no sclerotic osseous lesions identified. Mild degenerative changes involving the lumbar spine. CONCLUSION: 1. No metastatic disease is seen within the abdomen/pelvis. 2. Other chronic/incidental findings as outlined above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Minimal bibasilar subsegmental atelectasis. No suspicious nodule or mass identified. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No abnormality.. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Bilateral pelviectasis. No obstructing mass or stone visualized. Small left superior pole cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered diverticula without surrounding inflammation. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Moderate sized fat-containing umbilical hernia. MUSCULOSKELETAL: No acute or aggressive osseous abnormality, specifically no sclerotic osseous lesions identified. Mild degenerative changes involving the lumbar spine.
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FINDINGS: STRUCTURED REPORT: CT HCC Screening IMAGE QUALITY: Satisfactory LOWER CHEST: LUNG BASES / PLEURA: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Cirrhotic. No steatosis. LIVER LESIONS: None. The arterial enhancing segment 5 lesion previously seen on CT dated 3/16/2021 is not redemonstrated, suggesting perfusional abnormality. No suspicious arterial enhancement or regions of delayed washout. LIVER VASCULATURE AND COLLATERALS: - Hepatic artery patency and anatomy: Left hepatic artery arises from the left gastric artery. Patent arteries. - Portal venous system: Patent intra- and extra-hepatic portal venous system. - Hepatic veins: Patent right, middle and left hepatic veins. - Esophageal varices: None. - Other varices or collaterals: Coronary vein, perigastric, and perisplenic collaterals are unchanged. Splenorenal shunt is redemonstrated. LIVER RELATED FINDINGS: BILIARY DUCTS: Common bile duct measures up to 1.1 cm (series 11, image 119), similar to prior. GALLBLADDER: Distended with dependent radiopaque calculi. No wall thickening or pericholecystic fluid. LYMPH NODES: Scattered prominent retroperitoneal lymph nodes. SPLEEN: Unchanged splenomegaly measuring 15 cm. PERITONEUM / ASCITES: No ascites. OTHER FINDINGS: PANCREAS: Normal. ADRENALS: Normal. KIDNEYS: Few simple cysts are unchanged. No hydronephrosis bilaterally. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. MESENTERY: Normal. RETROPERITONEUM: Normal. OTHER VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesion.
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2,751
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RADIOLOGIC EXAM: CT Head wo contrast CLINICAL INFORMATION: AMS COMPARISON: None. TECHNIQUE: CT of the head without intravenous contrast. Scan field of view: 228 mm. DLP: 1250 mGy cm. FINDINGS: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. Mild diffuse brain volume loss,, slightly advanced for patient's age. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Normal. CONCLUSION: No acute intracranial process. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, acute infarct, or cerebral edema. No midline shift or mass effect. Mild diffuse brain volume loss,, slightly advanced for patient's age. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Normal.
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FINDINGS: No acute infarction, hemorrhage, or mass. Normal ventricles. Mucosal thickening in the posterior ethmoid air cells without underlying osseous changes. Paranasal sinuses are otherwise well-aerated. Bilateral mastoid air cells are clear. No acute fractures or suspicious osseous lesions. Normal orbits. Soft tissue nodule with dystrophic calcifications of the left frontal scalp (series 2, image 49).
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2,752
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EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: Recurrent infection, cough post COVID, GERD, concern for bronchiectasis. COMPARISON: Chest radiograph 3/23/2021. CT abdomen and pelvis 1/11/2021. TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 310 mm. DLP: 95.55 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory technique in supine position. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. No ground glass opacity, bronchiectasis, or subpleural reticulation. No honeycombing. HEART / VESSELS: Normal heart size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No aggressive osseous lesions. CONCLUSION: No significant intrathoracic abnormality, specifically no evidence of bronchiectasis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No focal consolidation, pleural effusion, or pneumothorax. No ground glass opacity, bronchiectasis, or subpleural reticulation. No honeycombing. HEART / VESSELS: Normal heart size. No pericardial effusion. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No aggressive osseous lesions.
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FINDINGS: BONES/JOINTS: There is a highly comminuted impacted left intertrochanteric fracture with extension through the greater and lesser trochanters and varus angulation. There is mild medial displacement of the lesser trochanter and mild lateral and posterior displacement of the greater trochanter. The bilateral femoral heads are well-seated within the acetabula. There is a chronic appearing deformity of the right superior pubic ramus. The sacroiliac joints are symmetric without significant widening. No pubic symphysis diastasis. Additionally, there is chronic deformity of the posterior left ilium, possibly representing postsurgical changes from prior bone harvest site; correlate with surgical history. There are multilevel discogenic degenerative changes facet hypertrophy of the lower lumbar spine resulting in mild right neural foramen narrowing at L3-L4, moderate right neuroforamen narrowing at L4-L5, and moderate right and severe left neuroforaminal narrowing at L5-S1. SOFT TISSUES: No large hematoma or fluid collection. The bladder is partially collapsed around a Foley catheter with air within the lumen. There is diverticulosis without evidence of acute diverticulitis. There are moderate atherosclerotic calcifications of the abdominal aorta. There are vascular stents within the bilateral iliac and left femoral arteries.
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2,753
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EXAM: CT Abdomen with contrast CLINICAL INFORMATION: 43-year-old male with history of testicular cancer; follow-up. COMPARISON: Multiple prior CTs of the abdomen pelvis, most recently 7/1/2021 TECHNIQUE: CT Abdomen with contrast. Patient weight: 277 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: 82sec Scan field of view: 450 mm. DLP: 950.20 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right renal hypodensities present characterized as cysts are again demonstrated, grossly unchanged. LYMPH NODES: Mildly prominent mesenteric and retroperitoneal lymph nodes, unchanged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: No evidence of metastatic disease within the abdomen or pelvis.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right renal hypodensities present characterized as cysts are again demonstrated, grossly unchanged. LYMPH NODES: Mildly prominent mesenteric and retroperitoneal lymph nodes, unchanged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: No retained foreign body. Airway is widely patent. No tonsillar/peritonsillar abscess. Uvula is midline. Epiglottis is normal in appearance. No prevertebral soft tissue swelling. No cervical lymphadenopathy or mass. The imaged intracranial structures are unremarkable. Trace mucosal thickening along the floor of the left maxillary sinus. Mastoid air cells are clear. Left posterior maxillary molar dental caries. The visualized lung apices are clear.
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2,754
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Left groin pain, concern for hernia or other COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 250 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec. Scan field of view: 416 mm. DLP: 1489 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Enlarged left inguinal node measuring 1.9 cm in maximal short axis with subtle. Additional mildly enlarged left external iliac node. No additional enlarged nodes STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. Right ovarian dominant follicle. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Mildly enlarged left inguinal and external iliac nodes are nonspecific but likely reactive lymphadenitis. 2. No additional abnormality identified.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: Enlarged left inguinal node measuring 1.9 cm in maximal short axis with subtle. Additional mildly enlarged left external iliac node. No additional enlarged nodes STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. Right ovarian dominant follicle. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Bibasilar subsegmental atelectasis. No focal lung consolidation, pleural effusion or pneumothorax. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Heart is normal in size. Moderate coronary calcifications. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Hyperdense biliary sludge. No abnormal gallbladder wall thickening. No definite radiopaque gallstones. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Atrophic bilateral kidneys. Several small hypoattenuating bilateral renal cortical lesions, most of them demonstrate simple fluid density without any enhancement suggesting simple cyst. There is small mildly hyperattenuating cortical lesion in the lateral right interpolar cortex which represents hemorrhagic/proteinaceous cysts. Tiny nonobstructing right renal calculi seen. No hydronephrosis or hydroureter. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach and duodenum partially distended. There is no abnormal dilatation of small bowel loops. COLON / APPENDIX: illeo-colonic post surgical changes. PERITONEUM / MESENTERY: No ascites or pneumoperitoneum. RETROPERITONEUM: Normal. VESSELS: Moderate to severe aortic calcifications. No aneurysmal dilatation. Severe calcifications at the origin of celiac trunk and superior mesenteric arteries. Moderate calcific lesions of bilateral external iliac arteries. URINARY BLADDER: Partially distended REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Large lower midline anterior abdominal wall hernia containing several small/large bowel loops and mesenteric fat without any obstruction or strangulation. MUSCULOSKELETAL: No acute osseous findings. Lumbar vertebrae demonstrate normal height.
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2,755
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: 69-year-old male with confirmed Covid pneumonia diagnosed three weeks ago. Possible new infection. COMPARISON: PET/CT dated 10/14/2021. TECHNIQUE: CT Chest wo contrast. Scan field of view: 350 mm. DLP: 292.50 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube tip in the trachea. Bilateral groundglass opacities, consolidations, and crazy paving pattern of both lungs. Developing reticulations predominantly in the right upper lobe. No suspicious nodule. Trace pleural effusions. HEART / VESSELS: Moderate CAD. Calcifications of the aortic valve. Mild atherosclerosis of the aorta and proximal great vessels. Left and right central venous catheter tips are seen in the SVC. MEDIASTINUM / ESOPHAGUS: Esophogastric tube in place with the tip in the stomach body. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Status post Cholecystectomy. MUSCULOSKELETAL: Kyphotic curvature of thoracic spine with decreased bone mineralization and mild spondylosis. No destructive osseous lesion. Wedging of the thoracic vertebral bodies appear chronic. CONCLUSION: Airspace disease findings are compatible with diagnosis of COVID pneumonia with developing of fibrotic lung disease. Trace pleural effusions and other incidental findings above.. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Endotracheal tube tip in the trachea. Bilateral groundglass opacities, consolidations, and crazy paving pattern of both lungs. Developing reticulations predominantly in the right upper lobe. No suspicious nodule. Trace pleural effusions. HEART / VESSELS: Moderate CAD. Calcifications of the aortic valve. Mild atherosclerosis of the aorta and proximal great vessels. Left and right central venous catheter tips are seen in the SVC. MEDIASTINUM / ESOPHAGUS: Esophogastric tube in place with the tip in the stomach body. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Status post Cholecystectomy. MUSCULOSKELETAL: Kyphotic curvature of thoracic spine with decreased bone mineralization and mild spondylosis. No destructive osseous lesion. Wedging of the thoracic vertebral bodies appear chronic.
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Findings: The left kidney and post auricular soft tissues are unremarkable. No masses seen. No bone invasion is identified. The right] orbital soft tissues appear normal. No tumor is seen. Underlying bone is intact. No skin lesion is seen in the soft tissues on either side of the face. The nasopharynx is unremarkable and the oral cavity and tongue base appear normal. No abnormal adenopathy is seen. The hypopharynx and larynx have normal appearance. The infraglottic visceral space appears normal. The remaining soft tissues of the neck are unremarkable. --------------
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2,756
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: 50-year-old male with flank pain and suspected kidney stone. COMPARISON: Ultrasound abdomen 6/11/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 420 mm. DLP: 1274.25 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild atelectasis at the right lung base. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Numerous irregular hypodensities scattered throughout the liver. The largest is located in the superior right hepatic lobe measuring 2.0 x 1.7 cm (series 2 image 57) with an average Hounsfield unit of 2, consistent with a cyst. BILIARY TRACT: Normal. GALLBLADDER: Contracted. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny punctate nonobstructing renal calculi within the left midpole. No hydronephrosis or ureteral calculus. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Multilevel discogenic degenerative changes with chronic bilateral L5 pars defects. Spinal stimulator is present. Anterior fixation hardware is present from L4 to S1. Early stage bilateral femoral head osteonecrosis. CONCLUSION: 1. Punctate nonobstructing calculus in the interpolar region of the left kidney. No ureteral calculus. 2. Early stage bilateral femoral head osteonecrosis. 3. Additional chronic and incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild atelectasis at the right lung base. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Numerous irregular hypodensities scattered throughout the liver. The largest is located in the superior right hepatic lobe measuring 2.0 x 1.7 cm (series 2 image 57) with an average Hounsfield unit of 2, consistent with a cyst. BILIARY TRACT: Normal. GALLBLADDER: Contracted. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny punctate nonobstructing renal calculi within the left midpole. No hydronephrosis or ureteral calculus. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is normal. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Multilevel discogenic degenerative changes with chronic bilateral L5 pars defects. Spinal stimulator is present. Anterior fixation hardware is present from L4 to S1. Early stage bilateral femoral head osteonecrosis.
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Findings: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. There are confluent periventricular low-attenuation white matter changes, small vessel ischemic disease. The ventricular system and extra-axial spaces our enlarged, likely related to diffuse cortical volume loss. There is near complete opacification of the right sphenoid sinus. The mastoid air cells are aerated. No calvarial fracture is identified. There is bilateral pseudophakia. There is calcified atherosclerotic disease of the internal carotid arteries.
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2,757
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: Endometrial cancer. Assess disease extent. COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 159 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 78 sec. Scan field of view: 375 mm. DLP: 596 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Small hypoattenuating focus in the right liver series 302 image 57. An additional ill-defined hypoattenuating lesion measures up to 1.1 cm and the right hepatic dome. BILIARY TRACT: No dilation. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multiple hypoattenuating foci in the kidneys, many of which are too small to characterize. Mild prominence of the right renal pelvis with mild enhancement noted. LYMPH NODES: Possible enlarged aortocaval lymph node on series 302 image 147 measures 1.6 x 1.4 cm. It is difficult to say if this is a true lymph node versus a portion of bowel although communication cannot be delineated on the coronal images. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Retroaortic left renal vein. URINARY BLADDER: Mass effect on the anterolateral urinary bladder secondary to uterine mass, indistinct from it posteriorly. REPRODUCTIVE ORGANS: There is necrotic tumor arising from the uterus that measures up to 4.2 x 3.2 cm on series 302 image 268. This extends inferior into the upper vagina/cervix region and involves the posterior uterine wall. Gas is seen extending into the endometrium which appears thickened. There are prominent gonadal veins extending to both ovaries. Both ovaries demonstrate a rounded peripherally enhancing cystic focus with tubular shaped foci surrounding the right ovary. This may also be seen to a lesser extent on the left. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive lesions. CONCLUSION: 1. Necrotic uterine mass consistent with known endometrial cancer. This involves the upper vagina/cervix region as well as the uterine wall. This is indistinct from the posterior bladder and involvement cannot be excluded. 2. Suspected metastatic aortocaval lymph node. There are also indeterminate hypoattenuating liver foci as described above. Further evaluation with liver MRI with Eovist is recommended given the difficulty of these areas for potential biopsy access percutaneously. 3. Other incidental and noncontributory findings as described above. Chest findings to be dictated separately; please see separate chest CT report same day. In addition tubular shaped areas in the right and potentially left adnexal areas could reflect hydrosalpinx. The cystic foci in both ovaries are indeterminate though could potentially be physiologic given the patient's age. Attention on follow-up is recommended.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Small hypoattenuating focus in the right liver series 302 image 57. An additional ill-defined hypoattenuating lesion measures up to 1.1 cm and the right hepatic dome. BILIARY TRACT: No dilation. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Multiple hypoattenuating foci in the kidneys, many of which are too small to characterize. Mild prominence of the right renal pelvis with mild enhancement noted. LYMPH NODES: Possible enlarged aortocaval lymph node on series 302 image 147 measures 1.6 x 1.4 cm. It is difficult to say if this is a true lymph node versus a portion of bowel although communication cannot be delineated on the coronal images. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Retroaortic left renal vein. URINARY BLADDER: Mass effect on the anterolateral urinary bladder secondary to uterine mass, indistinct from it posteriorly. REPRODUCTIVE ORGANS: There is necrotic tumor arising from the uterus that measures up to 4.2 x 3.2 cm on series 302 image 268. This extends inferior into the upper vagina/cervix region and involves the posterior uterine wall. Gas is seen extending into the endometrium which appears thickened. There are prominent gonadal veins extending to both ovaries. Both ovaries demonstrate a rounded peripherally enhancing cystic focus with tubular shaped foci surrounding the right ovary. This may also be seen to a lesser extent on the left. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No destructive lesions.
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FINDINGS: BONES/JOINTS: No acute fracture or malalignment. The bilateral femoral heads are well-seated within the acetabula. Sacroiliac joints are symmetric without significant widening. No pubic symphysis diastasis. A small ossific density projects superior to the left greater trochanter (series 210 image 161), likely representing remote trauma. SOFT TISSUES: No large hematoma or fluid collection. The bladder is distended.
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2,758
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EXAM: CT Chest with contrast CLINICAL INFORMATION: History of endometrial cancer. Rule out distant disease. COMPARISON: None. TECHNIQUE: CT Chest with contrast. Patient weight: 159 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. IV contrast injection rate: 3 ml per sec. Scan delay: 35 sec. Scan field of view: 345 mm. DLP: 202 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Subcentimeter left thyroid nodule. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Mild bilateral dependent atelectasis. No suspicious pulmonary nodules or masses. No pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. MUSCULOSKELETAL: Mild multilevel changes of the thoracic spine. CONCLUSION: No evidence of intrathoracic metastatic disease or acute abnormality. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Subcentimeter left thyroid nodule. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Mild bilateral dependent atelectasis. No suspicious pulmonary nodules or masses. No pleural effusion. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. MUSCULOSKELETAL: Mild multilevel changes of the thoracic spine.
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Findings: Brain parenchyma: Progressive predominantly frontoparietal age-appropriate brain parenchymal volume loss is seen, resulting in mild exvacuo dilatation of the ventricular system. Mild periventricular white matter hypoattenuation is again noted, suggestive of mild chronic microvascular ischemic disease. The brain parenchyma has a normal appearance. The white-gray matter differentiation is preserved. Basal cisterns: There is no significant effacement of the basilar cisterns. Extra-axial spaces: Normal appearance. No abnormal extra-axial fluid collections. Hemorrhage: No intracranial hemorrhage is identified. Midline shift: No significant midline shift is seen. Vascular system: Persistent atherosclerotic calcifications of the bilateral carotid siphons. Soft tissues: Unremarkable without discrete fluid collections. Orbits: Normal appearance. Interval development of bilateral lens replacements. Calvarium and skull base: No acute fractures or suspicious osseous lesions identified. The bilateral mastoid air cell complexes are well-developed and clear. Paranasal sinuses: Moderate opacification of the right sphenoid sinus with associated chronic osteitis, suggestive of chronic sinusitis. Progressive right maxillary sinus mucosal thickening, with mucous retention cysts. Otherwise, remain well aerated.
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2,759
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: 58-year-old male with urinary calculi; follow-up. COMPARISON: CT abdomen pelvis 11/29/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 425 mm. DLP: 1389.49 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Indeterminate subcentimeter hypodensity in the posterior dome, perhaps representing a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Nonobstructing 5 mm calculus in the interpolar region left kidney seen on axial series 2, image 118. No other renal or ureteral calculus. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Incompletely distended but with mild circumferential bladder wall thickening and minimal perivesicular stranding. Overall appearance not significantly changed from prior study. REPRODUCTIVE ORGANS: Prostate is surgically absent. BODY WALL: Redemonstration of a fat containing periumbilical hernia. Fat within the hernia and within the adjacent anterior omentum demonstrates inflammatory stranding. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Nonobstructive left nephrolithiasis. 2. Incompletely distended urinary bladder with mild urinary bladder wall thickening and perivesicular stranding. If there is clinical concern for cystitis, recommend correlation with urinalysis. 3. Small fat-containing periumbilical hernia with stranding of the associated fat and underlying omentum. Recommend clinical correlation with point tenderness in this region and for the presence of incarceration.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Indeterminate subcentimeter hypodensity in the posterior dome, perhaps representing a cyst. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Nonobstructing 5 mm calculus in the interpolar region left kidney seen on axial series 2, image 118. No other renal or ureteral calculus. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Incompletely distended but with mild circumferential bladder wall thickening and minimal perivesicular stranding. Overall appearance not significantly changed from prior study. REPRODUCTIVE ORGANS: Prostate is surgically absent. BODY WALL: Redemonstration of a fat containing periumbilical hernia. Fat within the hernia and within the adjacent anterior omentum demonstrates inflammatory stranding. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Mild, age-appropriate frontoparietal volume loss. Focal right parietotemporal chronic encephalomalacia, unchanged. Large area of posterior left cerebral hemisphere chronic cystic encephalomalacia, unchanged. Extensive confluent left greater than right cerebral white matter hypoattenuation, overall unchanged. Partial empty sella. Bilateral carotid siphon calcific atherosclerosis. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: Left frontoparietotemporal craniotomy flap, unchanged. VENTRICULAR SYSTEM: Stable position of right parietal approach ventriculostomy shunt catheter, terminating in an anterior parafalcine location. Stable ventriculomegaly with ex vacuo dilatation of the right lateral ventricle trigone and posterior left lateral ventricle secondary to encephalomalacia. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Left craniotomy postsurgical changes.
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2,760
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CT Cardiac with contrast CLINICAL INFORMATION: 67-year-old female with aortic stenosis year-old female undergoing evaluation for transcatheter aortic valve replacement. COMPARISON: No prior relevant studies available for comparison. TECHNIQUE: Pre contrast images were obtained to assess aortic valve and mitral annular calcifications. The postcontrast CT was performed using retrospective cardiac gating, followed by helical non gated CTA of the chest, abdomen and pelvis using single bolus of contrast. Images reviewed in multiple phases of the cardiac cycle. Source images, multiplanar reformatted images and volume rendered images were also reviewed. Patient was not given any medication Patient weight: 184 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 2 ml per sec. Scan delay: bt sec. Scan field of view: 184 mm. Heart Rate: 97 bpm. DLP: 1332 mGy cm. FINDINGS: The quality of study is excellent for evaluation of aortic root and was not tailored for coronary artery evaluation. There is moderate calcification of the tricuspid aortic leaflets with restricted opening during systole. The aortic root measurements done in systolic phase 30% are as follows (all using double oblique method): Annulus Dimensions: 20 x 25 mm Approximate Annulus Area: 393 mm2 Annulus Perimeter: 74 mm Distance of the left main (LM) coronary artery from Annulus: 12 mm Distance of the right coronary artery (RCA) from Annulus: 12 mm Left coronary sinus height: 19 mm Right coronary sinus height: 19 mm Aortic sinuses of Valsalva dimensions: 26 x 27 x 29 mm Sinotubular junction dimensions: 22 x 25 mm Mid ascending aorta dimensions: 28 x 29 mm Suitable Valve deployment angle: LAO = 10, cranial = 12 Aortic valve calcification score: 1107 LEFT VENTRICULAR VOLUMES AND SYSTOLIC FUNCTION: LVEF: 64 % LVED volume: 119 ml LVES volume: 43 ml LV Stroke volume: 76 ml The imaged lower neck is unremarkable. The central airways are patent. Mild bilateral dependent atelectasis. Expiratory exam with mild air trapping in the dependent lungs, which can be seen with small airway disease. No focal airspace consolidation, suspicious pulmonary nodules or masses or pleural effusion. Cardiac chambers are normal in size without pericardial effusion. Mild coronary artery atherosclerotic calcifications. Mild atherosclerotic disease of the thoracic aorta. The thoracic aorta and pulmonary arteries are normal in caliber. The esophagus and mediastinum are unremarkable. No mediastinal, hilar or axillary lymphadenopathy. The chest wall is unremarkable. Moderate multilevel degenerative changes of the thoracic spine. The CT of the abdomen and pelvis will be reported separately. CONCLUSION: 1. Calcific aortic stenosis with measured annulus size of 20 x 25 mm, annulus area of 393 sq mm and adequate distances of LM \T\ RCA to annulus. 2. Other measurements for percutaneous TAVR planning as above. 3. Other incidental findings as described. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: The quality of study is excellent for evaluation of aortic root and was not tailored for coronary artery evaluation. There is moderate calcification of the tricuspid aortic leaflets with restricted opening during systole. The aortic root measurements done in systolic phase 30% are as follows (all using double oblique method): Annulus Dimensions: 20 x 25 mm Approximate Annulus Area: 393 mm2 Annulus Perimeter: 74 mm Distance of the left main (LM) coronary artery from Annulus: 12 mm Distance of the right coronary artery (RCA) from Annulus: 12 mm Left coronary sinus height: 19 mm Right coronary sinus height: 19 mm Aortic sinuses of Valsalva dimensions: 26 x 27 x 29 mm Sinotubular junction dimensions: 22 x 25 mm Mid ascending aorta dimensions: 28 x 29 mm Suitable Valve deployment angle: LAO = 10, cranial = 12 Aortic valve calcification score: 1107 LEFT VENTRICULAR VOLUMES AND SYSTOLIC FUNCTION: LVEF: 64 % LVED volume: 119 ml LVES volume: 43 ml LV Stroke volume: 76 ml The imaged lower neck is unremarkable. The central airways are patent. Mild bilateral dependent atelectasis. Expiratory exam with mild air trapping in the dependent lungs, which can be seen with small airway disease. No focal airspace consolidation, suspicious pulmonary nodules or masses or pleural effusion. Cardiac chambers are normal in size without pericardial effusion. Mild coronary artery atherosclerotic calcifications. Mild atherosclerotic disease of the thoracic aorta. The thoracic aorta and pulmonary arteries are normal in caliber. The esophagus and mediastinum are unremarkable. No mediastinal, hilar or axillary lymphadenopathy. The chest wall is unremarkable. Moderate multilevel degenerative changes of the thoracic spine. The CT of the abdomen and pelvis will be reported separately.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis Chest findings to be dictated separately. ABDOMEN and PELVIS: LIVER: Hypoattenuating lesion along the posterior right hepatic lobe measures 3.2 x 1.8 cm (series 202, image 2:15). BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No abnormal renal parenchymal enhancement. There is mild bilateral hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is not definitively visualized. PERITONEUM / MESENTERY: Complex cystic lesion arising from the right adnexa measures 11.5 x 10.2 x 13.1 cm (series 202, image 388; series 204, image 143). A right upper quadrant complex cystic lesion measures 13.2 x 8.6 x 13.6 cm (series 202, image 292; series 204, image 207). There is diffuse peritoneal carcinomatosis, most significant within the left upper quadrant with small volume ascites. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus appears to be surgically absent. There is adjacent peritoneal nodularity within the pelvis. Right adnexal cystic lesion as detailed above. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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2,761
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EXAM: CT Angio Abdomen and Pelvis CLINICAL INFORMATION: AS, Z01.810 Encounter for preprocedural cardiovascular examination, I35.0 Nonrheumatic aortic (valve) stenosis Spec Inst: TAVR protocol per Dr. Singh COMPARISON: None. TECHNIQUE: CT Angio Abdomen and Pelvis. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 184 lbs. IV contrast: Omnipaque 350, 60 ml, per protocol. Saline flush: 60 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bt sec. Scan field of view: 493 mm. Heart Rate: 97 bpm. DLP: 1332 mGy cm. FINDINGS: STRUCTURED REPORT: CTA TAVR Protocol VASCULATURE: The right hepatic artery is replaced to the SMA. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT COMMON FEMORAL ARTERY: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT COMMON FEMORAL ARTERY: No significant abnormality. MEASUREMENTS: Right Common iliac dimensions: avg = 10, min = 8, max = 9 mm. Right External iliac dimensions: avg = 7, min = 6, max = 7 mm. Right Common femoral dimensions: avg = 7, min = 7, max = 7 mm. Left Common iliac dimensions: avg = 10, min = 10, max = 10 mm. Left External iliac dimensions: avg = 6, min = 6, max = 7 mm. Left Common femoral dimensions: avg = 7, min = 6, max = 7 mm. ------------------------------------------------------------- LOWER CHEST: A cardiac CTA was performed in conjunction with this examination and will be dictated in a separate report. Please see that report for all findings above the diaphragm. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No lymph node enlargement. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. The aorta, bilateral common iliac, external iliac, and common femoral arteries are patent. The internal diameters of these vessels are provided above.
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FINDINGS: STRUCTURED REPORT: CTA TAVR Protocol VASCULATURE: The right hepatic artery is replaced to the SMA. ABDOMINAL AORTA: No significant abnormality. CELIAC AXIS: No significant abnormality. SMA: No significant abnormality. RIGHT RENAL: No significant abnormality. LEFT RENAL: No significant abnormality. IMA: No significant abnormality. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT COMMON FEMORAL ARTERY: No significant abnormality. LEFT ILIAC ARTERIES: No significant abnormality. LEFT COMMON FEMORAL ARTERY: No significant abnormality. MEASUREMENTS: Right Common iliac dimensions: avg = 10, min = 8, max = 9 mm. Right External iliac dimensions: avg = 7, min = 6, max = 7 mm. Right Common femoral dimensions: avg = 7, min = 7, max = 7 mm. Left Common iliac dimensions: avg = 10, min = 10, max = 10 mm. Left External iliac dimensions: avg = 6, min = 6, max = 7 mm. Left Common femoral dimensions: avg = 7, min = 6, max = 7 mm. ------------------------------------------------------------- LOWER CHEST: A cardiac CTA was performed in conjunction with this examination and will be dictated in a separate report. Please see that report for all findings above the diaphragm. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No lymph node enlargement. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Normal. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: LINES AND TUBES: None. LOWER NECK: Thyroid goiter with multiple subcentimeter hypodense nodules. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: Mild coronary artery calcifications. Normal heart size. Normal caliber aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: See separate abdominal dictation. MUSCULOSKELETAL: No significant abnormality.
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2,762
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CT Head wo contrast Clinical Information: AMS Spec Inst: encephalopathy, on aspirin, please assess for acute process Comparison: None available Technique: Unenhanced axial brain CT with sagittal and coronal reformats. Scan field of view: 274.10 mm. DLP: 1389.40 mGy cm. Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. Mild periventricular hypoattenuation, consistent with chronic microangiopathic change. Mild diffuse atrophy with portion enlargement and ventricles and subarachnoid CSF spaces. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Mild ex vacuo ventriculomegaly. ORBITS: Bilateral lens replacements. Otherwise, unremarkable. SINUSES: There is a small amount fluid seen within the bilateral sphenoid sinuses but otherwise the visualized paranasal sinuses and mastoid air cells are clear. Conclusion: 1. No acute intracranial abnormality. Chronic findings as outlined above. 2. Bilateral sphenoid sinus fluid could suggest sphenoid sinusitis. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: CT head: BRAIN PARENCHYMA: No hemorrhage, intracranial mass, large territory infarct, or edema. Gray-white matter differentiation maintained. Mild periventricular hypoattenuation, consistent with chronic microangiopathic change. Mild diffuse atrophy with portion enlargement and ventricles and subarachnoid CSF spaces. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture. No aggressive osseous lesion. VENTRICULAR SYSTEM: Mild ex vacuo ventriculomegaly. ORBITS: Bilateral lens replacements. Otherwise, unremarkable. SINUSES: There is a small amount fluid seen within the bilateral sphenoid sinuses but otherwise the visualized paranasal sinuses and mastoid air cells are clear.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. The brain parenchyma volume appears normal. The white-gray matter differentiation is preserved. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No fracture. Previously seen fractures of the right nasal bone/frontal process of the right maxilla has healed. There are multiple dental caries and periapical lucencies. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. SOFT TISSUES: Unremarkable without discrete fluid collections. Incidental right superior orbital rim piercing.
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2,763
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: 67-year-old male with kidney stones. COMPARISON: CT abdomen and pelvis 12/7/2021 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 410 mm. DLP: 345 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild dependent atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged location of the nonobstructing right upper pole renal calculi measuring up to 5 mm (series 2 image 138). Interval passage of the obstructing stone at the right UVJ with resolution of the previous upstream hydroureteronephrosis. The left kidney is unremarkable without renal calculi or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not well-visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Mild discogenic degenerative changes of the thoracolumbar spine. No aggressive osseous lesions. CONCLUSION: 1. Interval passage of the stone at the right UVJ with resolution of the upstream hydroureteronephrosis. 2. Unchanged nonobstructing renal calculi within the right upper renal pole. 3. Additional chronic and incidental findings as described above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Mild dependent atelectasis. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Unchanged location of the nonobstructing right upper pole renal calculi measuring up to 5 mm (series 2 image 138). Interval passage of the obstructing stone at the right UVJ with resolution of the previous upstream hydroureteronephrosis. The left kidney is unremarkable without renal calculi or hydronephrosis. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. The appendix is not well-visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Mild atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Mild discogenic degenerative changes of the thoracolumbar spine. No aggressive osseous lesions.
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Findings: The sagittal images demonstrate straightening and slight reversal of the cervical lordosis, with subtle grade 1 anterolisthesis of C6 on C7. Acute displaced fracture of the right C7 superior and inferior facets, extending into the right C7 transverse process and transverse foramen, resulting in perched right C6-C7 facet joint. The vertebral bodies otherwise maintain normal height, without acute fractures or suspicious osseous lesions. No significant intervertebral disc space narrowing or extensive degenerative changes are identified. No significant neural foraminal narrowing or central spinal canal stenosis is seen. The craniocervical junction appears unremarkable. The prevertebral and paraspinal soft tissues appear normal.
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2,764
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 75-year-old female with unintended weight loss. COMPARISON: CT abdomen pelvis 6/2/2021. TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 104 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 66 sec. Scan field of view: 350 mm. DLP: 443.80 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: Unchanged left lobe medial segment hepatic cyst. BILIARY TRACT: Intra and extrahepatic biliary ductal dilation tapering to normal at the pancreas head, stable compared to prior. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny hypodensity within the posterior left kidney is too small to characterize, likely representing a cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Incompletely evaluated due to streak artifact from right total hip arthroplasty. REPRODUCTIVE ORGANS: Incompletely evaluated due to streak artifact from right total hip arthroplasty. The uterus is surgically absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Discogenic degenerative changes of the thoracolumbar spine. No aggressive osseous lesions. CONCLUSION: 1. No abnormality within the abdomen or pelvis to explain the patient's unintentional weight loss. 2. Stable chronic and incidental findings as described above. 3. Please see separately dictated same-day CT chest. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Please see separately dictated same-day CT chest. ABDOMEN and PELVIS: LIVER: Unchanged left lobe medial segment hepatic cyst. BILIARY TRACT: Intra and extrahepatic biliary ductal dilation tapering to normal at the pancreas head, stable compared to prior. GALLBLADDER: Surgically absent. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Tiny hypodensity within the posterior left kidney is too small to characterize, likely representing a cyst. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. The appendix is not well visualized. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Moderate atherosclerotic calcifications of the abdominal aorta which is normal in caliber. URINARY BLADDER: Incompletely evaluated due to streak artifact from right total hip arthroplasty. REPRODUCTIVE ORGANS: Incompletely evaluated due to streak artifact from right total hip arthroplasty. The uterus is surgically absent. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Discogenic degenerative changes of the thoracolumbar spine. No aggressive osseous lesions.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: No suspicious pulmonary nodule. Mild to moderate centrilobular emphysema bilaterally with bronchial wall thickening. Dependent atelectasis bilaterally. Central airways are patent. No focal consolidation, pleural effusion, or pneumothorax. Foci of pleural calcifications bilaterally. HEART / VESSELS: Biatrial dilation. No pericardial effusion. Severe coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Circumferential thickening of the distal esophagus. LYMPH NODES: Prominent lymph nodes throughout the mediastinum and bilateral hila, none pathologically enlarged. CHEST WALL: Pedunculated cutaneous nodule along the right axilla measuring up to 0.8 cm in diameter on series 2 image 15, stable compared to prior examination. Bilateral gynecomastia. Subcutaneous nodularity in the back (series 2 image 43) is also unchanged. UPPER ABDOMEN: Cirrhotic morphology of the liver, dense calcification present in the anterior right hepatic lobe. Perigastric and perisplenic varices are present, incompletely evaluated without intravenous contrast. Cholelithiasis without CT evidence of acute cholecystitis. Scattered calcified granulomata within the spleen. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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2,765
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EXAM: CT Chest with contrast CLINICAL INFORMATION: Weight loss, unintended. Per chart review, history of dysphagia and night sweats. COMPARISON: CT chest 6/2/2021. TECHNIQUE: CT Chest with contrast. Patient weight: 104 lbs. IV contrast: Omnipaque 350, 80 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 66 sec. Scan field of view: 350 mm. FINDINGS: LOWER NECK: Postsurgical changes related to interval left supraclavicular nodal dissection. CHEST: LUNGS / AIRWAYS / PLEURA: There is increased size transplant nodular opacity right middle lobe measuring 15 x 10 mm (image 163, series #203). There is interval development of well-defined nodularity in the right upper and middle lobes, the largest nodule measuring 10 x 8 mm (image 104, series #203). New ill-defined somewhat nodular opacities are also visualized in the left lower lobe (for example image 115, series #203). There is grossly stable appearance of bilateral tree-in-bud opacities and scattered consolidation, predominantly involving in the right lower lobe. There is mucous within the small right lower lobe bronchi with associated peribronchial thickening, similar to prior exam. No pneumothorax or pleural effusion. HEART / VESSELS: Normal heart size. No pericardial effusion. Moderate multivessel coronary atherosclerosis. Mild atherosclerosis of the thoracic aorta and arch vessels. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia, with mild thickening of the distal esophageal wall. LYMPH NODES: Increased size of the subcarinal lymph node measuring 3.0 x 1.7 cm (image 118, series #203), previously 2.4 x 1.6 cm. Similar appearance of mildly enlarged mediastinal lymph nodes and conglomerate of right lower paratracheal nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see separately reported same day CT abdomen and pelvis. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the thoracic spine. CONCLUSION: 1. Interval worsening with development of multiple nodular opacities, with persistent extensive tree-in-bud opacities, predominantly in the dependent right lung, likely related to aspiration pneumonia/bronchiolitis. 2. Increased size of the enlarged subcarinal lymph node with associated shotty mediastinal lymph nodes, likely reactive., Continued attention at follow-up studies is recommended. 3. Small hiatal hernia with findings thickening of the distal esophageal wall which may be secondary to reflux. 4. Other incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: LOWER NECK: Postsurgical changes related to interval left supraclavicular nodal dissection. CHEST: LUNGS / AIRWAYS / PLEURA: There is increased size transplant nodular opacity right middle lobe measuring 15 x 10 mm (image 163, series #203). There is interval development of well-defined nodularity in the right upper and middle lobes, the largest nodule measuring 10 x 8 mm (image 104, series #203). New ill-defined somewhat nodular opacities are also visualized in the left lower lobe (for example image 115, series #203). There is grossly stable appearance of bilateral tree-in-bud opacities and scattered consolidation, predominantly involving in the right lower lobe. There is mucous within the small right lower lobe bronchi with associated peribronchial thickening, similar to prior exam. No pneumothorax or pleural effusion. HEART / VESSELS: Normal heart size. No pericardial effusion. Moderate multivessel coronary atherosclerosis. Mild atherosclerosis of the thoracic aorta and arch vessels. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia, with mild thickening of the distal esophageal wall. LYMPH NODES: Increased size of the subcarinal lymph node measuring 3.0 x 1.7 cm (image 118, series #203), previously 2.4 x 1.6 cm. Similar appearance of mildly enlarged mediastinal lymph nodes and conglomerate of right lower paratracheal nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Please see separately reported same day CT abdomen and pelvis. MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel discogenic degenerative changes of the thoracic spine.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: New moderate left and mild right hydroureter nephrosis. There is bilateral ureteral enhancement and thickening. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Diverticulosis without evidence of diverticulitis. Otherwise, the colon, including the appendix, is normal. PERITONEUM / MESENTERY: Normal. Is similar to prior without definite well-defined mass. RETROPERITONEUM: Soft tissue nodule overlying the right iliacus muscle belly measures 1.2 x 0.9 cm (series 2, image 201), increased compared to prior examination. VESSELS: Left common and external iliac stent is hypoattenuating within the midportion (series 2, image 264). Additionally, there is significant mass effect on the right common and external iliac veins from associated pelvic sidewall stranding. There is moderate atherosclerotic calcification of the abdominal aorta which is normal in caliber. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The uterus is surgically absent. Pelvic sidewall stranding as above. No adnexal masses. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No aggressive osseous lesions.
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2,766
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: Left upper quadrant pain COMPARISON: 9/6/2013 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 500 mm. Oral contrast Omnipaque: 16.9 oz. DLP: 1482.92 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary calcifications visualized. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis is again noted without evidence of cholecystitis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No specific perirenal stranding bilaterally. No hydroureteronephrosis. No contour altering focal lesion. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. A normal appendix is not visualized, however a small appendiceal stump may be present. PERITONEUM / MESENTERY: Loculated fluid collections within the right lateral abdomen and within the right hemipelvis previously visualized in 2013 are not seen on today's exam. There is no free air or free fluid. RETROPERITONEUM: Normal. VESSELS: The caliber of the abdominal aorta is within normal limits. Mild scattered calcified atherosclerosis noted. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The prostate is within normal limits. Calcification of the bilateral vas deferens noted. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Focal sclerotic lesion adjacent to the right acetabulum appears consistent with bone island. Degenerative changes involving the lumbar spine, hips, and sacroiliac joints. CONCLUSION: 1. No acute abnormality to explain the patient's left upper quadrant pain is seen on unenhanced CT of the abdomen/pelvis. 2. Cholelithiasis and other chronic/incidental findings as outlined above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: Coronary calcifications visualized. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis is again noted without evidence of cholecystitis. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: No specific perirenal stranding bilaterally. No hydroureteronephrosis. No contour altering focal lesion. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. A normal appendix is not visualized, however a small appendiceal stump may be present. PERITONEUM / MESENTERY: Loculated fluid collections within the right lateral abdomen and within the right hemipelvis previously visualized in 2013 are not seen on today's exam. There is no free air or free fluid. RETROPERITONEUM: Normal. VESSELS: The caliber of the abdominal aorta is within normal limits. Mild scattered calcified atherosclerosis noted. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The prostate is within normal limits. Calcification of the bilateral vas deferens noted. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No acute or aggressive osseous abnormality. Focal sclerotic lesion adjacent to the right acetabulum appears consistent with bone island. Degenerative changes involving the lumbar spine, hips, and sacroiliac joints.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Mild mucosal thickening in the right maxillary sinus and left ethmoid air cells. Small mucosal retention cyst in the right maxillary sinus. The remainder of the visualized paranasal sinuses and mastoid air cells are clear. SOFT TISSUES:Unremarkable.
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2,767
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Lung Cancer Screening Clinical Information: Lung cancer screening Technique: Scan field of view: 335 mm. Height: 69 in. Patient weight: 172 lbs. CTDI vol: 2.44 mGy. DLP: 88.52 mGy cm. 0.63 mm images were obtained through the chest. The CT is jointly interpreted by Drs. Singh and Terry Smoking Status: Former If not current, quit years ago: 14 Pack Years: 30 Screen Year: 3. Procedures number Comparison: December 3, 2020 Interpretation and recommendations are based on 2019 version of ACR LungRads recommendations Findings: Small nodes in the mediastinum especially right lower paratracheal region are stable. Mild diffuse increased peribronchial thickening and mild upper lobe centrilobular emphysema with dependent atelectatic changes in both upper and lower lobes. Mild lower lobe bronchiectasis is also suspected. Previously noted left upper lobe tiny nodule is not well seen. There is a tiny right lower lobe noncalcified 2 mm nodule in image 325, series 2. A few tiny fissural nodules are unchanged. Linear atelectasis is present in the inferior lingula. There is no pleural or pericardial effusion. Coronary artery calcification: The visual score of calcification in remains stable at 1. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The visualized liver, spleen, adrenals, and bowel are unremarkable. Bones: There is no focal lytic or sclerotic bone lesion. Impression: Mild COPD with no suspicious lung nodule. LungRads category: 2 Lung-Rads Modifier S: No clinically significant or potentially clinically significant findings. Recommendation: Continue yearly low-dose lung cancer screening CT. ====================================================================================== REFERENCES: http://www.acr.org/\R\/media/ACR/Documents/PDF/QualitySafety/Resources/LungRADS/AssessmentCateg ries http://www.acr.org/Quality-Safety/Lung-Cancer-Screening-Center Category 0: Incomplete. Category 1: Negative - No nodules or definitely benign nodules. Category 2: Benign Appearance or Behavior - Nodules with a very low likelihood of becoming a clinically active cancer due to size or lack of growth. Category 3: Probably benign finding(s) - Short term follow-up suggested; includes nodules with a low likelihood of becoming a clinically active cancer. Category 4A: Suspicious - Findings for which additional diagnostic testing is recommended. Category 4B and 4X: Very Suspicious - Findings for which additional diagnostic testing and/or tissue sampling is recommended. Modifier S: Other Findings - Clinically significant or potentially clinically significant findings (non-lung cancer). References: http://www.acr.org/\R\/media/ACR/Documents/PDF/QualitySafety/Resources/LungRADS/AssessmentCateg ries http://www.acr.org/Quality-Safety/Lung-Cancer-Screening-Center
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Findings: Small nodes in the mediastinum especially right lower paratracheal region are stable. Mild diffuse increased peribronchial thickening and mild upper lobe centrilobular emphysema with dependent atelectatic changes in both upper and lower lobes. Mild lower lobe bronchiectasis is also suspected. Previously noted left upper lobe tiny nodule is not well seen. There is a tiny right lower lobe noncalcified 2 mm nodule in image 325, series 2. A few tiny fissural nodules are unchanged. Linear atelectasis is present in the inferior lingula. There is no pleural or pericardial effusion. Coronary artery calcification: The visual score of calcification in remains stable at 1. (Based on a publication by Kirsch et al (Detection of Coronary calcium During Standard Chest Computed Tomography Correlates With Multi-Detector Computed Tomography Coronary Artery Calcium score, Int J Cardiovasc Imaging (2012) 28:1249-1256), visual score >7 is associated with an Agatston score > 400 and independently validated increased incidence of cardiovascular mortality). The visualized liver, spleen, adrenals, and bowel are unremarkable. Bones: There is no focal lytic or sclerotic bone lesion.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Groundglass opacities of the lateral right middle lobe likely represents pulmonary contusion. Trace bibasilar dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced fractures of the right anterior 2nd-7th ribs. Nondisplaced fracture of the left lateral 4th rib. Asymmetric gynecomastia, right greater than left. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Vicarious contrast excretion. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. Few prominent, but nonenlarged mesenteric lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Residual contrast within the urinary bladder. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Rib fractures as detailed above. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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2,768
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EXAM: CT Chest with contrast CLINICAL INFORMATION: 60-year-old male with testicular malignancy. COMPARISON: Outside CT chest dated 10/4/2021. TECHNIQUE: CT Chest with contrast. Patient weight: 199 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 86 sec. Scan field of view: 407 mm. DLP: 935.30 mGy cm. FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Multiple noncalcified bilateral pulmonary nodules are again seen, with interval improvement. Some of the nodules have completely resolved. A representative peripheral right upper lobe nodule measures 5 mm on axial image 91; series 202, previously measured 11 mm. A peripheral left upper lobe nodule measures 4 mm on axial image 91; series 2, previously measured 7 mm. No new nodule. No pleural effusion. HEART / VESSELS: Left atrium appears enlarged. Pulmonary artery calcifications. Left-sided portacatheter terminates in SVC. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Significant interval improvement in the mediastinum lymphadenopathy. Representative AP window node measures 1.2 x 0.6 cm on axial image 84; series 2, pretwo 0.9 x 2.3 cm (axial image 71; series 2). CHEST WALL: No significant abnormality. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No destructive osseous lesion. CONCLUSION: Significant interval improvement in pulmonary metastatic nodules and mediastinal lymph nodes. No new nodule.
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FINDINGS: LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Central airways are patent. Multiple noncalcified bilateral pulmonary nodules are again seen, with interval improvement. Some of the nodules have completely resolved. A representative peripheral right upper lobe nodule measures 5 mm on axial image 91; series 202, previously measured 11 mm. A peripheral left upper lobe nodule measures 4 mm on axial image 91; series 2, previously measured 7 mm. No new nodule. No pleural effusion. HEART / VESSELS: Left atrium appears enlarged. Pulmonary artery calcifications. Left-sided portacatheter terminates in SVC. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Significant interval improvement in the mediastinum lymphadenopathy. Representative AP window node measures 1.2 x 0.6 cm on axial image 84; series 2, pretwo 0.9 x 2.3 cm (axial image 71; series 2). CHEST WALL: No significant abnormality. UPPER ABDOMEN: Reported separately. MUSCULOSKELETAL: No destructive osseous lesion.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Groundglass opacities of the lateral right middle lobe likely represents pulmonary contusion. Trace bibasilar dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced fractures of the right anterior 2nd-7th ribs. Nondisplaced fracture of the left lateral 4th rib. Asymmetric gynecomastia, right greater than left. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Vicarious contrast excretion. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. Few prominent, but nonenlarged mesenteric lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Residual contrast within the urinary bladder. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Rib fractures as detailed above. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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2,769
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 60-year-old man with malignant germ cell tumor. Evaluate metastatic disease. COMPARISON: 5/19/2021 (outside CT from Fort Walton Beach Medical Center) TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 199 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 86 sec. Scan field of view: 407 mm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT performed today will be reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: An enlarged low attenuation retrocaval lymph node today measures 1.9 x 1.4 cm (image 292 series 202); was 0.6 x 0.4 cm (image 39 series 2). Partially calcified left para-aortic lymph node located just below the left renal vein today measures 1.5 x 1.3 cm (image 269 series 202); was 1.4 x 1.1 cm (image 33 series 2). STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The prostate contains multiple coarse calcifications likely resulting from prior episodes of prostatitis. Postsurgical changes of left orchiectomy are noted. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Bilateral hip, sacroiliac, and diffuse lumbar degenerative change. CONCLUSION: 1. Increasing but small volume retroperitoneal adenopathy consistent with metastatic disease. 2. Incidental findings as above. 3. Please see chest CT report for details in that region.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: Chest CT performed today will be reported separately. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: An enlarged low attenuation retrocaval lymph node today measures 1.9 x 1.4 cm (image 292 series 202); was 0.6 x 0.4 cm (image 39 series 2). Partially calcified left para-aortic lymph node located just below the left renal vein today measures 1.5 x 1.3 cm (image 269 series 202); was 1.4 x 1.1 cm (image 33 series 2). STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: The prostate contains multiple coarse calcifications likely resulting from prior episodes of prostatitis. Postsurgical changes of left orchiectomy are noted. BODY WALL: Small fat-containing umbilical hernia. MUSCULOSKELETAL: Bilateral hip, sacroiliac, and diffuse lumbar degenerative change.
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,770
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EXAM: CT Chest High Resolution wo contrast CLINICAL INFORMATION: Chronic bronchitis. COMPARISON: None. TECHNIQUE: CT Chest High Resolution wo contrast. Scan field of view: 300 mm. DLP: 172.21 mGy cm. High-resolution CT imaging of the chest was performed per protocol with inspiratory and expiratory technique in prone position. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Residual thymus. Otherwise unremarkable. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Normal.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Normal. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Residual thymus. Otherwise unremarkable. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Groundglass opacities of the lateral right middle lobe likely represents pulmonary contusion. Trace bibasilar dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced fractures of the right anterior 2nd-7th ribs. Nondisplaced fracture of the left lateral 4th rib. Asymmetric gynecomastia, right greater than left. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Vicarious contrast excretion. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. Few prominent, but nonenlarged mesenteric lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Residual contrast within the urinary bladder. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Rib fractures as detailed above. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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2,771
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CT Angio Neck, CT Angio Head wo+w contrast 1/6/2022 3:32 PM Clinical Information: Innominate thrombosis, Z98.890 Other specified postprocedural states Spec Inst: Evaluate Aortic Arch Comparison: Chest CT dated 12/20/2021 Technique: Noncontrast axial head CT images were obtained. Axial CT angiogram images were obtained through the head and neck. Delayed postcontrast images were also obtained through the head. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated. Patient weight: 220 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BOLUS TRACK sec. Scan field of view: 250 mm. DLP: 4079.85 mGy cm. (accession CT220003302), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BOLUS TRACK, 180 SEC. sec. Scan field of view: 250 mm. DLP: 4079.85 mGy cm. (accession CT220003303) Findings: Noncontrast head CT: No acute intracranial abnormality. No intracranial hemorrhage. Mild white matter microangiopathic changes. No hydrocephalus. No acute or aggressive osseous lesion. Paranasal sinuses and mastoid air cells are clear. CT angiography: There is motion artifact, partly degrading evaluation. Aortic arch: No new abnormality within aortic arch. Ascending aortic graft appears unremarkable. The vascular graft from the ascending aorta to the right innominate artery bifurcation remains thrombosed. The right common carotid and right subclavian arteries show adequate opacification with a prominent ipsilateral vertebral artery. Right carotid: Proximal most portion of the right common carotid is partially obscured by image streak artifacts. Advanced atherosclerotic disease at the carotid bulb and post bifurcation internal carotid with severe luminal stenosis. The proximal two thirds of the cervical internal carotids show a string-like lumen which opens up briefly The skull base before it becomes severely narrowed again at the petrous intracranial segment. There continues to be severe stenosis with near occlusion throughout the cavernous, paraclinoid and supraclinoid ICA with moderately narrowed but slightly improved caliber in the terminal ICA with bifurcation into the ACA and MCA branches which are patent but minimally smaller compared to the left. There is partial retropharyngeal course of the right internal carotid artery. Left carotid: Mild atherosclerotic disease without evidence of flow-limiting cervical or intracranial left carotid stenoses. Right vertebral artery: Evaluation is degraded by motion artifact. However, at the origin of the right vertebral artery, there is an atherosclerotic calcifications with luminal stenosis causing possibly moderate stenosis. No other flow-limiting cervical or intracranial right vertebral artery stenoses. Left vertebral artery: No cervical or intracranial left vertebral artery stenoses are evident. Intracranial vessels: There is a focal outpouching, likely aneurysm from the left mid A1 segment at a branch point, measuring approximately 2.5 mm in diameter (best seen on coronal series 601 at image 78). Persistent fetal rightposterior cerebral artery. Relatively less opacification of the right transverse and sigmoid sinus and internal jugular vein, could be from contrast timing. The lingual tonsils are prominent. There is no cervical adenopathy is noted. ---------------- Conclusion: 1. No acute intracranial abnormality on noncontrast exam. 2. Ascending aortic graft appears unremarkable. Ascending aorta to brachiocephalic graft remains occluded. Adequate opacification of the right subclavian and right common carotid artery likely from retrograde flow from the well opacified patent right vertebral artery. Moderate stenosis is suspected at the origin of the right vertebral artery however. 3. Severe right carotid bulb and internal carotid atherosclerotic disease with severe long segment stenosis with multifocal near occlusion extending from the proximal cervical internal carotid to the internal carotid terminus. Reconstitution of the right ACA and MCA branches which are relatively slightly smaller than the left. 4. A 2.5 mm aneurysm arising from the left ACA A1 segment. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Noncontrast head CT: No acute intracranial abnormality. No intracranial hemorrhage. Mild white matter microangiopathic changes. No hydrocephalus. No acute or aggressive osseous lesion. Paranasal sinuses and mastoid air cells are clear. CT angiography: There is motion artifact, partly degrading evaluation. Aortic arch: No new abnormality within aortic arch. Ascending aortic graft appears unremarkable. The vascular graft from the ascending aorta to the right innominate artery bifurcation remains thrombosed. The right common carotid and right subclavian arteries show adequate opacification with a prominent ipsilateral vertebral artery. Right carotid: Proximal most portion of the right common carotid is partially obscured by image streak artifacts. Advanced atherosclerotic disease at the carotid bulb and post bifurcation internal carotid with severe luminal stenosis. The proximal two thirds of the cervical internal carotids show a string-like lumen which opens up briefly The skull base before it becomes severely narrowed again at the petrous intracranial segment. There continues to be severe stenosis with near occlusion throughout the cavernous, paraclinoid and supraclinoid ICA with moderately narrowed but slightly improved caliber in the terminal ICA with bifurcation into the ACA and MCA branches which are patent but minimally smaller compared to the left. There is partial retropharyngeal course of the right internal carotid artery. Left carotid: Mild atherosclerotic disease without evidence of flow-limiting cervical or intracranial left carotid stenoses. Right vertebral artery: Evaluation is degraded by motion artifact. However, at the origin of the right vertebral artery, there is an atherosclerotic calcifications with luminal stenosis causing possibly moderate stenosis. No other flow-limiting cervical or intracranial right vertebral artery stenoses. Left vertebral artery: No cervical or intracranial left vertebral artery stenoses are evident. Intracranial vessels: There is a focal outpouching, likely aneurysm from the left mid A1 segment at a branch point, measuring approximately 2.5 mm in diameter (best seen on coronal series 601 at image 78). Persistent fetal rightposterior cerebral artery. Relatively less opacification of the right transverse and sigmoid sinus and internal jugular vein, could be from contrast timing. The lingual tonsils are prominent. There is no cervical adenopathy is noted. ----------------
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Groundglass opacities of the lateral right middle lobe likely represents pulmonary contusion. Trace bibasilar dependent atelectasis. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Normal. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: Minimally displaced fractures of the right anterior 2nd-7th ribs. Nondisplaced fracture of the left lateral 4th rib. Asymmetric gynecomastia, right greater than left. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Vicarious contrast excretion. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. Few prominent, but nonenlarged mesenteric lymph nodes. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Residual contrast within the urinary bladder. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Tiny fat-containing umbilical hernia. MUSCULOSKELETAL: Rib fractures as detailed above. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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2,772
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CT Angio Neck, CT Angio Head wo+w contrast 1/6/2022 3:32 PM Clinical Information: Innominate thrombosis, Z98.890 Other specified postprocedural states Spec Inst: Evaluate Aortic Arch Comparison: Chest CT dated 12/20/2021 Technique: Noncontrast axial head CT images were obtained. Axial CT angiogram images were obtained through the head and neck. Delayed postcontrast images were also obtained through the head. 3-D CT angiographic images were generated from the axial data set. "Sliding MIP" images were also generated. Patient weight: 220 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BOLUS TRACK sec. Scan field of view: 250 mm. DLP: 4079.85 mGy cm. (accession CT220003302), Patient weight: 220 lbs. IV contrast: Omnipaque 350, 125 ml, per protocol. Saline flush: 10 ml. IV contrast injection rate: 4 ml per sec. Scan delay: BOLUS TRACK, 180 SEC. sec. Scan field of view: 250 mm. DLP: 4079.85 mGy cm. (accession CT220003303) Findings: Noncontrast head CT: No acute intracranial abnormality. No intracranial hemorrhage. Mild white matter microangiopathic changes. No hydrocephalus. No acute or aggressive osseous lesion. Paranasal sinuses and mastoid air cells are clear. CT angiography: There is motion artifact, partly degrading evaluation. Aortic arch: No new abnormality within aortic arch. Ascending aortic graft appears unremarkable. The vascular graft from the ascending aorta to the right innominate artery bifurcation remains thrombosed. The right common carotid and right subclavian arteries show adequate opacification with a prominent ipsilateral vertebral artery. Right carotid: Proximal most portion of the right common carotid is partially obscured by image streak artifacts. Advanced atherosclerotic disease at the carotid bulb and post bifurcation internal carotid with severe luminal stenosis. The proximal two thirds of the cervical internal carotids show a string-like lumen which opens up briefly The skull base before it becomes severely narrowed again at the petrous intracranial segment. There continues to be severe stenosis with near occlusion throughout the cavernous, paraclinoid and supraclinoid ICA with moderately narrowed but slightly improved caliber in the terminal ICA with bifurcation into the ACA and MCA branches which are patent but minimally smaller compared to the left. There is partial retropharyngeal course of the right internal carotid artery. Left carotid: Mild atherosclerotic disease without evidence of flow-limiting cervical or intracranial left carotid stenoses. Right vertebral artery: Evaluation is degraded by motion artifact. However, at the origin of the right vertebral artery, there is an atherosclerotic calcifications with luminal stenosis causing possibly moderate stenosis. No other flow-limiting cervical or intracranial right vertebral artery stenoses. Left vertebral artery: No cervical or intracranial left vertebral artery stenoses are evident. Intracranial vessels: There is a focal outpouching, likely aneurysm from the left mid A1 segment at a branch point, measuring approximately 2.5 mm in diameter (best seen on coronal series 601 at image 78). Persistent fetal rightposterior cerebral artery. Relatively less opacification of the right transverse and sigmoid sinus and internal jugular vein, could be from contrast timing. The lingual tonsils are prominent. There is no cervical adenopathy is noted. ---------------- Conclusion: 1. No acute intracranial abnormality on noncontrast exam. 2. Ascending aortic graft appears unremarkable. Ascending aorta to brachiocephalic graft remains occluded. Adequate opacification of the right subclavian and right common carotid artery likely from retrograde flow from the well opacified patent right vertebral artery. Moderate stenosis is suspected at the origin of the right vertebral artery however. 3. Severe right carotid bulb and internal carotid atherosclerotic disease with severe long segment stenosis with multifocal near occlusion extending from the proximal cervical internal carotid to the internal carotid terminus. Reconstitution of the right ACA and MCA branches which are relatively slightly smaller than the left. 4. A 2.5 mm aneurysm arising from the left ACA A1 segment. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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Findings: Noncontrast head CT: No acute intracranial abnormality. No intracranial hemorrhage. Mild white matter microangiopathic changes. No hydrocephalus. No acute or aggressive osseous lesion. Paranasal sinuses and mastoid air cells are clear. CT angiography: There is motion artifact, partly degrading evaluation. Aortic arch: No new abnormality within aortic arch. Ascending aortic graft appears unremarkable. The vascular graft from the ascending aorta to the right innominate artery bifurcation remains thrombosed. The right common carotid and right subclavian arteries show adequate opacification with a prominent ipsilateral vertebral artery. Right carotid: Proximal most portion of the right common carotid is partially obscured by image streak artifacts. Advanced atherosclerotic disease at the carotid bulb and post bifurcation internal carotid with severe luminal stenosis. The proximal two thirds of the cervical internal carotids show a string-like lumen which opens up briefly The skull base before it becomes severely narrowed again at the petrous intracranial segment. There continues to be severe stenosis with near occlusion throughout the cavernous, paraclinoid and supraclinoid ICA with moderately narrowed but slightly improved caliber in the terminal ICA with bifurcation into the ACA and MCA branches which are patent but minimally smaller compared to the left. There is partial retropharyngeal course of the right internal carotid artery. Left carotid: Mild atherosclerotic disease without evidence of flow-limiting cervical or intracranial left carotid stenoses. Right vertebral artery: Evaluation is degraded by motion artifact. However, at the origin of the right vertebral artery, there is an atherosclerotic calcifications with luminal stenosis causing possibly moderate stenosis. No other flow-limiting cervical or intracranial right vertebral artery stenoses. Left vertebral artery: No cervical or intracranial left vertebral artery stenoses are evident. Intracranial vessels: There is a focal outpouching, likely aneurysm from the left mid A1 segment at a branch point, measuring approximately 2.5 mm in diameter (best seen on coronal series 601 at image 78). Persistent fetal rightposterior cerebral artery. Relatively less opacification of the right transverse and sigmoid sinus and internal jugular vein, could be from contrast timing. The lingual tonsils are prominent. There is no cervical adenopathy is noted. ----------------
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. Gray-white matter differentiation is maintained. Cerebral cortical volume is normal. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SKULL AND SKULL BASE: No fracture. FACIAL BONES: Normal. MANDIBLE: Normal. SINONASAL CAVITIES: Mild mucosal thickening in the right maxillary sinus and left ethmoid air cells. Small mucosal retention cyst in the right maxillary sinus. The remainder of the visualized paranasal sinuses and mastoid air cells are clear. SOFT TISSUES:Unremarkable.
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2,773
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EXAM: CT Abdomen wo+w contrast CLINICAL INFORMATION: 55-year-old female with epigastric pain and unintentional weight loss. COMPARISON: None. TECHNIQUE: CT Abdomen wo+w contrast. Patient weight: 169 lbs. IV contrast: Omnipaque 350, 143 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: Bolus Tracked. Scan field of view: 400 mm. DLP: 1962.63 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Large partially calcified nodule in the medial left lower lobe measures 2.0 cm on axial series 11, image 54. Additional 4 mm noncalcified nodule in the posterior right lower lobe on axial series 11, image 1. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Well-circumscribed, lobulated hypodensity in the left hepatic lobe, most suggestive of a cyst. Additional well-circumscribed hypodensities in the left lobe are also suggestive of cysts. BILIARY TRACT: Expected postcholecystectomy prominence of the common bile duct. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Minimal atherosclerotic disease. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No evident etiology to account for the patient's epigastric pain. 2. Large partially calcified left lower lobe lung nodule with additional noncalcified right lower lobe nodule. Although of uncertain etiology, this may be related to a history of granulomatous disease.
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FINDINGS: STRUCTURED REPORT: CT Abdomen LOWER CHEST: LUNG BASES / PLEURA: Large partially calcified nodule in the medial left lower lobe measures 2.0 cm on axial series 11, image 54. Additional 4 mm noncalcified nodule in the posterior right lower lobe on axial series 11, image 1. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN: LIVER: Well-circumscribed, lobulated hypodensity in the left hepatic lobe, most suggestive of a cyst. Additional well-circumscribed hypodensities in the left lobe are also suggestive of cysts. BILIARY TRACT: Expected postcholecystectomy prominence of the common bile duct. GALLBLADDER: Surgically absent. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Minimal atherosclerotic disease. BODY WALL: No significant abnormality. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,774
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EXAM: CT Abdomen and Pelvis wo IV contrast CLINICAL INFORMATION: 54-year-old female with renal calculi; follow-up. COMPARISON: Multiple prior CTs of the abdomen pelvis, most recently 10/20/2020 TECHNIQUE: CT Abdomen and Pelvis wo IV contrast. Scan field of view: 450 mm. DLP: 1134.89 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Mildly complex right lower pole renal cystic lesion not well evaluated given the lack of intravenous contrast but appearing grossly unchanged. Bilateral nonobstructive nephrolithiasis. The largest stone in the right kidney is in the lower pole and measures approximately 5 mm on axial series 2, image 128. The largest stone in the left kidney is located in the upper pole and measures approximately 4 mm on axial series 2, image 90. Left distal ureteral calculus has passed since the prior study. Calcification adjacent to the right ureter, likely a phlebolith. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing periumbilical hernia. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. Interval passage of the left distal ureteral calculus. Additional bilateral nonobstructing calculi are noted. 2. Limited evaluation of the mildly complex right lower pole renal cystic lesion, likely not significantly changed. 3. Small hiatal hernia.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Small hiatal hernia. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal for technique. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal for technique. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Mildly complex right lower pole renal cystic lesion not well evaluated given the lack of intravenous contrast but appearing grossly unchanged. Bilateral nonobstructive nephrolithiasis. The largest stone in the right kidney is in the lower pole and measures approximately 5 mm on axial series 2, image 128. The largest stone in the left kidney is located in the upper pole and measures approximately 4 mm on axial series 2, image 90. Left distal ureteral calculus has passed since the prior study. Calcification adjacent to the right ureter, likely a phlebolith. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Small hiatal hernia. COLON / APPENDIX: Scattered colonic diverticuli without associated inflammation. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small fat-containing periumbilical hernia. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: No acute pulmonary embolus is identified. Main pulmonary artery is mildly enlarged measuring 3.4 cm. LUNGS / AIRWAYS / PLEURA: Moderate centrilobular emphysema. Patchy bilateral peripheral predominant groundglass and consolidative opacities. Spiculated nodule in the right upper lobe measuring 1.7 x 0.9 cm (series 401 image 51). Small right effusion with associated atelectasis. Diffuse peribronchial thickening. Central airways are patent. There is smooth interlobular septal thickening. HEART / OTHER VESSELS: Severe calcified atherosclerosis without aneurysm. Three-vessel coronary atherosclerosis. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: Multiple mildly enlarged mediastinal nodes, for example, a cardiophrenic node measuring 0.8 cm (series 401 image 107) and a subcarinal node measuring 1.5 cm (image 75). CHEST WALL: Bilateral gynecomastia. UPPER ABDOMEN: Unremarkable. MUSCULOSKELETAL: Degenerative spine changes. Mild anterior wedging of T3, age indeterminate.
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2,775
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: Rule out metastases. Unspecified viral hepatitis C. Alcoholic liver disease. COMPARISON: None. TECHNIQUE: CT Chest wo contrast. Scan field of view: 370 mm. DLP: 193.79 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small bilateral pleural effusions and adjacent passive atelectasis. Tiny nodular opacities along the right lung minor fissure, likely fissural lymph nodes. Tiny nonspecific 1 to 2 mm nodule in the left upper lobe (series 2; image 80). HEART / VESSELS: Normal heart size. Small pericardial effusion. Moderate coronary artery calcifications. Mildly ectatic ascending aorta measuring up to 4.2 cm at the level of the main pulmonary artery. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. Paraesophageal varices. LYMPH NODES: Mildly prominent mediastinal lymph nodes, none of which are enlarged by CT criteria, likely related to the underlying liver disease. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Cirrhotic morphology of the liver. Ascites. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: 1. No intrathoracic metastatic disease. 2. Small bilateral pleural effusions with adjacent atelectasis. 3. Signs of cirrhosis with portal hypertension.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small bilateral pleural effusions and adjacent passive atelectasis. Tiny nodular opacities along the right lung minor fissure, likely fissural lymph nodes. Tiny nonspecific 1 to 2 mm nodule in the left upper lobe (series 2; image 80). HEART / VESSELS: Normal heart size. Small pericardial effusion. Moderate coronary artery calcifications. Mildly ectatic ascending aorta measuring up to 4.2 cm at the level of the main pulmonary artery. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. Paraesophageal varices. LYMPH NODES: Mildly prominent mediastinal lymph nodes, none of which are enlarged by CT criteria, likely related to the underlying liver disease. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Cirrhotic morphology of the liver. Ascites. MUSCULOSKELETAL: No significant abnormality.
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FINDINGS: STRUCTURED REPORT: CTA Chest VASCULATURE: CORONARY ARTERIES: There are mild atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Enlarged main pulmonary artery up to 32 mm. Filling defect seen in the right upper lobe posterior branch is likely artifactual in nature as is only seen on a single view. ASCENDING THORACIC AORTA: No significant abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: Minimal proximal atherosclerotic disease. DESCENDING THORACIC AORTA: Minimal atherosclerotic disease. UPPER ABDOMINAL AORTA: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bandlike subsegmental atelectasis in the right upper lobe with volume loss and elevation of the right hemidiaphragm. Minimal septal line prominence. Left greater than right dependent consolidations. Left upper lobe calcified granuloma. Minimal secretions within the trachea. Expiratory phase respiratory. HEART / OTHER VESSELS: Cardiomegaly. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Calcified mediastinal and left hilar nodes.. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Postcholecystectomy changes. MUSCULOSKELETAL: No significant abnormality.
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2,776
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CT Neck Soft Tissue w contrast 1/6/2022 3:46 PM Clinical Information: Squamous cell carcinoma, C80.1 Malignant (primary) neoplasm, unspecified Comparison: Neck CT 10/14/2021 Technique: The neck was studied from the skull base to the thoracic inlet during contrast infusion, following an initial loading bolus of contrast. Patient weight: 124 lbs. IV contrast: Omnipaque 350, 100 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 235 sec. Scan field of view: 296 mm. DLP: 309.90 mGy cm. Findings: Extensive postsurgical changes in the oral cavity and right neck are again noted with numerous surgical clips and associated streak artifact. Within the limitation from streak artifact, no obvious neck mass is noted. The mildly enlarged left level IA lymph node is again seen and appears stable. There are postsurgical changes along the superior cortical surface of the anterior mandible with slightly smoother margins compared to previously, likely from remodeling and/or postsurgical changes. There is no progression of the lucency along the superior cortical surface. There is no involvement of the inferior mandible. Adjacent soft tissue thickening is likely postsurgical without any discrete obvious enhancing mass clearly identified on this study. Mildly atrophic thyroid gland is unchanged. Atherosclerotic calcifications are again noted. Right subinsular gland is surgically absent. Left submandibular gland and bilateral parotid glands appear unremarkable. The visualized intracranial structures appear normal. There is no other cervical adenopathy by size criteria. Impression: 1. Postsurgical changes within the neck, oral cavity and along the anterior mandible with no progression of the mandibular cortical surface irregularity and lucency. 2. Stable mildly enlarged left level IA lymph node. No other cervical adenopathy by size criteria.
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Findings: Extensive postsurgical changes in the oral cavity and right neck are again noted with numerous surgical clips and associated streak artifact. Within the limitation from streak artifact, no obvious neck mass is noted. The mildly enlarged left level IA lymph node is again seen and appears stable. There are postsurgical changes along the superior cortical surface of the anterior mandible with slightly smoother margins compared to previously, likely from remodeling and/or postsurgical changes. There is no progression of the lucency along the superior cortical surface. There is no involvement of the inferior mandible. Adjacent soft tissue thickening is likely postsurgical without any discrete obvious enhancing mass clearly identified on this study. Mildly atrophic thyroid gland is unchanged. Atherosclerotic calcifications are again noted. Right subinsular gland is surgically absent. Left submandibular gland and bilateral parotid glands appear unremarkable. The visualized intracranial structures appear normal. There is no other cervical adenopathy by size criteria.
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Findings: There is slight diffuse atrophy and there is commensurate slight prominence of the ventricles but no hydrocephalus. There are hypodensities in the cerebellum ependymal and deep white matter, likely microvascular ischemia. There is no mass, hemorrhage, visible infarct or extracerebral collection. The posterior fossa contents are unremarkable. There is no defect in the calvarium or skull base. Compared to the prior CT scan on 1/20/2022 is no significant change. See the MR head on 1/19/2022. ---------------
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2,777
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EXAM: CT Rsh Chest with contrast METRIC CLINICAL INFORMATION: Baseline evaluation, ovarian cancer. COMPARISON: None. TECHNIQUE: CT Rsh Chest with contrast METRIC. Patient weight: 182 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 97 sec. Scan field of view: 430 mm. DLP: 1314.89 mGy cm. FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small subcentimeter left lung apex nodule (series 2; image 40). HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: Enlarged mediastinal and bilateral hilar lymph nodes. CHEST WALL: A left chest port terminates in the right atrium near the cavoatrial junction. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. MUSCULOSKELETAL: No significant abnormality. CONCLUSION: Mediastinal and bilateral hilar lymph node metastases. 2. Small subcentimeter left apical nodule. Attention to this on subsequent examinations is recommended. This patient is participating in a clinical trial and a separate Tumor Metrics report will be provided and include tumor measurements as applicable for response assessment.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Small subcentimeter left lung apex nodule (series 2; image 40). HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. LYMPH NODES: Enlarged mediastinal and bilateral hilar lymph nodes. CHEST WALL: A left chest port terminates in the right atrium near the cavoatrial junction. UPPER ABDOMEN: Please note that the concurrently obtained CT scan of the Abdomen will be dictated separately. MUSCULOSKELETAL: No significant abnormality.
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Findings: CTA neck: The top of the aortic arch and the brachiocephalic arteries have expected appearance. The left common carotid artery and its apparently occluded from its origin to the stent in the distal common carotid artery. There is opacification of the left ICA however there is marked narrowing at C4 and there is poor definition of C2. The terminal left cervical ICA is essentially negative. There is severe stenosis at the right carotid bifurcation with dense calcified plaques which obscure the lumen. The upper right cervical ICA is unremarkable. Both vertebral arteries are sizable, left larger than right, with tortuosity but no apparent defect. There are laminectomies of C3 through C7 and there are posterior fusion construct with pedicle screws and rods from C2 to T1. CTA head: There are dense calcifications in the cavernous ICAs and prominent tortuosity but no apparent flow limiting stenosis. There is slight junctional dilatation at the origin of the left PCOM. The proximal ACAs, PCAs are unremarkable. The basilar artery and its branches are intact. There are dense calcifications in the terminal segment of the large left vertebral artery. There are atherosclerotic changes with narrowing of the mid basilar artery and also narrowing of the basilar terminus. No aneurysm, AVM or intrinsic vascular lesion is seen. ---------------
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2,778
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CT Angio Head wo+w contrast HISTORY: 42-year-old patient with history of ischemic heart disease headache and clinical concern for intracerebral aneurysm Technique: After the administration of IV contrast bolus, 2.5 mm images were obtained and reformatted in the 1.4 mm overlapping images. 3-D CT MIP and Volume rendered angiographic images were generated In postprocessing from the axial data set. "Sliding MIP" images were also generated in the sagittal, axial, and coronal planes. COMPARISON: None available. FINDINGS: Noncontrast head CT: No acute intrathoracic abnormality. No intracranial hemorrhage. No brain mass or brain edema. No hydrocephalus. There is a partially empty sella. There is no abnormal intracranial enhancement. Normal orbits. No aggressive osseous lesion. Paranasal sinuses and mastoid air cells are clear. CT angiography: There is a a tiny 1 x 1 mm aneurysm projecting inferior laterally arising from the supraclinoid left internal carotid artery (series 604 image 67 and series 605 image 88) immediately distal to posterior communicating artery origin. No other evidence of aneurysmal dilatation or significant stenosis of the skull base segments of internal carotid arteries. The anterior, middle, and posterior cerebral arteries are normal in course, caliber, and contour. Hypoplastic right vertebral artery. Normal left vertebral artery. Basilar artery is diffusely small but without focal stenosis in keeping with fetal origin of bilateral PCAs.. IMPRESSION: 1. No acute intracranial abnormality. 2. Tiny aneurysm projecting inferior and laterally laterally arising from the left supraclinoid internal carotid artery immediately distal to posterior communicating artery takeoff. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: Noncontrast head CT: No acute intrathoracic abnormality. No intracranial hemorrhage. No brain mass or brain edema. No hydrocephalus. There is a partially empty sella. There is no abnormal intracranial enhancement. Normal orbits. No aggressive osseous lesion. Paranasal sinuses and mastoid air cells are clear. CT angiography: There is a a tiny 1 x 1 mm aneurysm projecting inferior laterally arising from the supraclinoid left internal carotid artery (series 604 image 67 and series 605 image 88) immediately distal to posterior communicating artery origin. No other evidence of aneurysmal dilatation or significant stenosis of the skull base segments of internal carotid arteries. The anterior, middle, and posterior cerebral arteries are normal in course, caliber, and contour. Hypoplastic right vertebral artery. Normal left vertebral artery. Basilar artery is diffusely small but without focal stenosis in keeping with fetal origin of bilateral PCAs..
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Findings: CTA neck: The top of the aortic arch and the brachiocephalic arteries have expected appearance. The left common carotid artery and its apparently occluded from its origin to the stent in the distal common carotid artery. There is opacification of the left ICA however there is marked narrowing at C4 and there is poor definition of C2. The terminal left cervical ICA is essentially negative. There is severe stenosis at the right carotid bifurcation with dense calcified plaques which obscure the lumen. The upper right cervical ICA is unremarkable. Both vertebral arteries are sizable, left larger than right, with tortuosity but no apparent defect. There are laminectomies of C3 through C7 and there are posterior fusion construct with pedicle screws and rods from C2 to T1. CTA head: There are dense calcifications in the cavernous ICAs and prominent tortuosity but no apparent flow limiting stenosis. There is slight junctional dilatation at the origin of the left PCOM. The proximal ACAs, PCAs are unremarkable. The basilar artery and its branches are intact. There are dense calcifications in the terminal segment of the large left vertebral artery. There are atherosclerotic changes with narrowing of the mid basilar artery and also narrowing of the basilar terminus. No aneurysm, AVM or intrinsic vascular lesion is seen. ---------------
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2,779
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EXAM: CT Abdomen and Pelvis w contrast CLINICAL INFORMATION: 45-year-old female with left-sided abdominal and flank pain. COMPARISON: CT abdomen and pelvis 5/25/2021 TECHNIQUE: CT Abdomen and Pelvis w contrast. Patient weight: 246 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 3 ml per sec. Scan delay: 90 sec. Scan field of view: 380 mm. DLP: 1976.10 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Subtle scattered groundglass opacities in bilateral lung bases, new from prior. Calcified granuloma in the left lung base. No other significant abnormality. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: There is focal fatty infiltration along the intersegmental fissure. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild diffuse fatty atrophy. No other significant abnormality. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Wedge-shaped area of hypoenhancement in the left lower renal pole. Right lower pole renal cyst. No hydronephrosis or significant perinephric stranding. There are small nonobstructive bilateral nephrolithiasis suggested. LYMPH NODES: Slightly prominent retroperitoneal lymph nodes are unchanged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Uncomplicated diverticulosis. Ventral hernia containing nondilated colon. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: No other significant abnormality. VESSELS: No significant abnormality. URINARY BLADDER: Circumferential bladder wall thickening. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal mass. BODY WALL: Large ventral hernia containing nondilated colon. Additional small fat-containing periumbilical hernia. Minimal subcutaneous stranding along the left abdominal pannus and dystrophic calcification. MUSCULOSKELETAL: Chronic degenerative changes of the visualized thoracolumbar spine. No acute osseous abnormality. Mild chronic diastases of the symphysis pubis. CONCLUSION: 1. Small wedge-shaped area of hypoenhancement in the left lower renal pole and recommend correlation for pyelonephritis. Small renal infarct is thought less likely. Circumferential bladder wall thickening which can be seen with cystitis. 2. Scattered groundglass opacities in bilateral lung bases which may be infectious/inflammatory in etiology, are new from prior and Covid infection is not excluded. 3. Large ventral hernia containing nondilated colon. 4. Minimal subcutaneous stranding along the left anterior abdominal wall pannus and cellulitis is not excluded. Additional chronic and incidental findings as above. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Subtle scattered groundglass opacities in bilateral lung bases, new from prior. Calcified granuloma in the left lung base. No other significant abnormality. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: There is focal fatty infiltration along the intersegmental fissure. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Mild diffuse fatty atrophy. No other significant abnormality. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Wedge-shaped area of hypoenhancement in the left lower renal pole. Right lower pole renal cyst. No hydronephrosis or significant perinephric stranding. There are small nonobstructive bilateral nephrolithiasis suggested. LYMPH NODES: Slightly prominent retroperitoneal lymph nodes are unchanged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Uncomplicated diverticulosis. Ventral hernia containing nondilated colon. Appendix is normal. PERITONEUM / MESENTERY: Normal. No free fluid. RETROPERITONEUM: No other significant abnormality. VESSELS: No significant abnormality. URINARY BLADDER: Circumferential bladder wall thickening. REPRODUCTIVE ORGANS: Uterus is surgically absent. No adnexal mass. BODY WALL: Large ventral hernia containing nondilated colon. Additional small fat-containing periumbilical hernia. Minimal subcutaneous stranding along the left abdominal pannus and dystrophic calcification. MUSCULOSKELETAL: Chronic degenerative changes of the visualized thoracolumbar spine. No acute osseous abnormality. Mild chronic diastases of the symphysis pubis.
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Findings: There is no abnormal decreased CBF or elevated transient time to suggest significant ischemia or infarction at the territory of major intracranial arteries. CT perfusion is suboptimal in technique. There is motion artifact during the CT and the arterial and venous curves are not standard.
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2,780
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EXAM: CT Rsh Body with contrast METRIC CLINICAL INFORMATION: Ovarian cancer. Baseline evaluation for research study. COMPARISON: 11/11/2021 TECHNIQUE: CT Rsh Body with contrast METRIC. Patient weight: 182 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Oral contrast Omnipaque: 16.9 oz. Saline flush: 20 ml. IV contrast injection rate: 2 ml per sec. Scan delay: 97 sec. Scan field of view: 430 mm. DLP: 1314.89 mGy cm. FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: The pancreas is unremarkable. Peripancreatic peritoneal nodule has enlarged from the prior exam. SPLEEN: Normal size with adjacent small splenule. ADRENALS: Normal. KIDNEYS: Focal lobulation of the renal cortex on series 2 image 227 versus a small solid lesion is similar to prior. Mild dilation of the bilateral ureters in the midportion. LYMPH NODES: Multiple retroperitoneal lymph nodes are enlarged, some of which appear necrotic. These have also in part enlarged from prior. STOMACH / SMALL BOWEL: No bowel obstruction. There is some prominence of the distal small bowel mucosa. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: Increased peritoneal carcinomatosis with more prominent peritoneal/omental stranding and new and enlarging peritoneal nodules. Trace fluid, possibly enhancing in the pelvis with minimal nodularity. RETROPERITONEUM: Otherwise unremarkable. VESSELS: Right gonadal vein thrombus. Scattered atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prior hysterectomy. BODY WALL: Bowel and fat-containing umbilical hernia. Multiple prior injection granulomas. A partially fat density focus is seen posteriorly on series 2 image 355. MUSCULOSKELETAL: No destructive lesions. Degenerative changes in the spine. CONCLUSION: 1. Increased retroperitoneal adenopathy and peritoneal carcinomatosis as described above. Possible fluid/nodularity in the deep pelvis. Attention on follow-up is recommended. 2. A partial fat density focus in the posterior gluteal region may reflect fat necrosis although attention on follow-up is suggested. 3. Focal lobulation of the right renal cortex is favored to reflect lobulated tissue versus less likely a mass lesion given its stability over multiple prior examinations. 4. Other incidental and noncontributory findings as described above. Chest findings to be dictated separately; please see separate chest CT report same day. This patient is participating in a clinical trial and a separate Tumor Metrics report will be provided and include tumor measurements as applicable for response assessment.
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: The pancreas is unremarkable. Peripancreatic peritoneal nodule has enlarged from the prior exam. SPLEEN: Normal size with adjacent small splenule. ADRENALS: Normal. KIDNEYS: Focal lobulation of the renal cortex on series 2 image 227 versus a small solid lesion is similar to prior. Mild dilation of the bilateral ureters in the midportion. LYMPH NODES: Multiple retroperitoneal lymph nodes are enlarged, some of which appear necrotic. These have also in part enlarged from prior. STOMACH / SMALL BOWEL: No bowel obstruction. There is some prominence of the distal small bowel mucosa. COLON / APPENDIX: Diverticulosis. PERITONEUM / MESENTERY: Increased peritoneal carcinomatosis with more prominent peritoneal/omental stranding and new and enlarging peritoneal nodules. Trace fluid, possibly enhancing in the pelvis with minimal nodularity. RETROPERITONEUM: Otherwise unremarkable. VESSELS: Right gonadal vein thrombus. Scattered atherosclerosis. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prior hysterectomy. BODY WALL: Bowel and fat-containing umbilical hernia. Multiple prior injection granulomas. A partially fat density focus is seen posteriorly on series 2 image 355. MUSCULOSKELETAL: No destructive lesions. Degenerative changes in the spine.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Stable biapical nodular scarring. Ill-defined nodularity on a background of groundglass opacity in the right lung apex is stable in appearance. Few scattered bilateral, less than 3mm pulmonary nodules (series 2 image 87 for example). Other previously noted scattered pulmonary nodularity is not definitively visualized on this examination. No new suspicious pulmonary nodule is identified. Mild to moderate apical predominant centrilobular emphysema. Linear scarring/atelectasis in both lung bases is unchanged. No focal consolidation, pleural effusion, or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild atherosclerotic calcifications of the thoracic aorta. Mild coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Prominent mediastinal lymph nodes, none pathologically enlarged. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Bilateral adrenal thickening, stable. Otherwise normal noncontrast appearance of the imaged upper abdomen. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality. Degenerative changes in spine.
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2,781
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 279 mm. DLP: 1444 mGy cm. (accession CT220003313), Scan field of view: 220 mm. DLP: 1049.70 mGy cm. (accession CT220003319) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture evident. Ununited appearance of the anterior and posterior arch of C1, developmental. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL CT: Age indeterminate bilateral nasal bone irregularity. No nasal septal abnormality. No additional facial fractures. Orbits appear maintained. The globes are intact. The mandible is intact. The TMJs are appropriately positioned. There are impacted bilateral maxillary and mandibular molars. Several dental caries and a chronically absent appearing right maxillary molar. Soft tissue contusive changes at the left face peripheral to the left zygomatic arch. CONCLUSION: 1. No acute intracranial process. 2. Age indeterminate nasal bone fractures. Otherwise, no acute maxillofacial fractures evident. 3. Left sided facial contusive changes.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture evident. Ununited appearance of the anterior and posterior arch of C1, developmental. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL CT: Age indeterminate bilateral nasal bone irregularity. No nasal septal abnormality. No additional facial fractures. Orbits appear maintained. The globes are intact. The mandible is intact. The TMJs are appropriately positioned. There are impacted bilateral maxillary and mandibular molars. Several dental caries and a chronically absent appearing right maxillary molar. Soft tissue contusive changes at the left face peripheral to the left zygomatic arch.
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FINDINGS: AORTIC MEASUREMENTS: AORTIC ROOT AT THE SINUSES: 3.4 x 3.2 x 3.2 cm, previously 3.4 x 3.3 x 3.2 MID-ASCENDING THORACIC AORTA (measured on axial image 216 series 301) : 4.3 x 4.0 cm, previously 4.2 x 4.0. AORTIC ARCH: 3.5 x 3.2 cm, previously 3.4 x 3.1. PROXIMAL DESCENDING THORACIC AORTA: 2.9 x 2.6 cm, previously 2.2 x 2.0 but difference is likely technical. MID DESCENDING THORACIC AORTA: 2.5 x 2.3 cm, previously 2.4 x 2.2. DISTAL DESCENDING THORACIC AORTA: 2.4 x 2.1 cm, previously 2.5 x 2.3. STRUCTURED REPORT: CTA Chest VASCULATURE: CORONARY ARTERIES: There are no atherosclerotic calcifications of the native coronary arteries. PULMONARY ARTERIES: No central pulmonary embolus. Normal size. ASCENDING THORACIC AORTA: Ectatic without additional abnormality. AORTIC ARCH: No significant abnormality. ARCH VESSELS: No significant abnormality. DESCENDING THORACIC AORTA: No significant abnormality. UPPER ABDOMINAL AORTA: No significant abnormality. ------------------------------------------------------------- LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Patent central airways. No focal consolidation, pneumothorax, or pleural effusion. No suspicious pulmonary nodule. HEART / OTHER VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Circumferential distal esophageal wall thickening with air-fluid level in mid esophagus. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal. MUSCULOSKELETAL: No aggressive osseous lesion. Degenerative disc disease with thoracic dextroscoliosis.
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2,782
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 116 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. DLP: 577.50 mGy cm. (accession CT220003314), Patient weight: 116 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. (accession CT220003315) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There are scattered groundglass opacities seen within the left upper and lower lobes with a suspected trace anterior left pneumothorax. No pleural effusion.. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: There is a small indeterminate hypodensity seen within the spleen on image 205, series 501, technically indeterminate but thought less likely related to trauma. There is no perisplenic free fluid. ADRENALS: Normal. KIDNEYS: There is a small linear hypodensity seen in the upper pole of the left kidney which is technically indeterminate seen best on coronal image 67, series 503.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is a mildly displaced fracture of the left superior and inferior pubic ramus. There is a mildly displaced acute zone 2 fracture of the left sacrum involving the left S1, S2, and probably S3 neuroforamen. There is a mildly displaced fracture of the left iliac wing that involves the left SI joint with minimal left SI joint diastases. There is lucency/cortical absence seen within the superior sternum without associated soft tissue mass, indeterminate. Bilateral os acromiale are noted. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Left sacral fracture. Left superior and inferior pubic rami fracture. Left iliac bone fracture involving the left SI joint which minimal left SI joint diastases. 2. Multifocal left pulmonary contusions with trace left pneumothorax. No definite rib fracture identified. 3. Indeterminate linear hypodensity in the upper pole left kidney. A tiny grade 2 splenic injury cannot be entirely excluded. 4. Small indeterminate splenic hypodensity. Grade 1 injury is difficult to exclude but thought less likely. There is no perisplenic free fluid. Attention on follow-up. 5. Lytic lesion/lack of ossification involving the sternum and xiphoid process, of uncertain etiology. This could be due to lack of cartilaginous ossification/developmental. However, clinical correlation and follow-up recommended. 6. No acute fracture or dislocation of the thoracic or lumbar spine. 7. Additional findings above.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There are scattered groundglass opacities seen within the left upper and lower lobes with a suspected trace anterior left pneumothorax. No pleural effusion.. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: There is a small indeterminate hypodensity seen within the spleen on image 205, series 501, technically indeterminate but thought less likely related to trauma. There is no perisplenic free fluid. ADRENALS: Normal. KIDNEYS: There is a small linear hypodensity seen in the upper pole of the left kidney which is technically indeterminate seen best on coronal image 67, series 503.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is a mildly displaced fracture of the left superior and inferior pubic ramus. There is a mildly displaced acute zone 2 fracture of the left sacrum involving the left S1, S2, and probably S3 neuroforamen. There is a mildly displaced fracture of the left iliac wing that involves the left SI joint with minimal left SI joint diastases. There is lucency/cortical absence seen within the superior sternum without associated soft tissue mass, indeterminate. Bilateral os acromiale are noted. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: Ballistic: Brain parenchyma appears normal in density. No evidence of acute infarction, intracranial hemorrhage, hydrocephalus or extra-axial fluid collection is seen. Four paranasal sinuses and orbits please refer to the dedicated CT of same date. The skull base segments of the internal carotid arteries are normal in course, caliber, and contour. The anterior, middle, and posterior cerebral arteries are normal in course, caliber, and contour. The intradural segments of the vertebral arteries as well as the basilar artery are normal in course, caliber, and contour. The left P-comm is patent and the right P-comm is not visualized. There is no evidence for saccular aneurysm, vascular malformation, or large vessel occlusion.
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2,783
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 116 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. DLP: 577.50 mGy cm. (accession CT220003314), Patient weight: 116 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. (accession CT220003315) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There are scattered groundglass opacities seen within the left upper and lower lobes with a suspected trace anterior left pneumothorax. No pleural effusion.. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: There is a small indeterminate hypodensity seen within the spleen on image 205, series 501, technically indeterminate but thought less likely related to trauma. There is no perisplenic free fluid. ADRENALS: Normal. KIDNEYS: There is a small linear hypodensity seen in the upper pole of the left kidney which is technically indeterminate seen best on coronal image 67, series 503.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is a mildly displaced fracture of the left superior and inferior pubic ramus. There is a mildly displaced acute zone 2 fracture of the left sacrum involving the left S1, S2, and probably S3 neuroforamen. There is a mildly displaced fracture of the left iliac wing that involves the left SI joint with minimal left SI joint diastases. There is lucency/cortical absence seen within the superior sternum without associated soft tissue mass, indeterminate. Bilateral os acromiale are noted. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Left sacral fracture. Left superior and inferior pubic rami fracture. Left iliac bone fracture involving the left SI joint which minimal left SI joint diastases. 2. Multifocal left pulmonary contusions with trace left pneumothorax. No definite rib fracture identified. 3. Indeterminate linear hypodensity in the upper pole left kidney. A tiny grade 2 splenic injury cannot be entirely excluded. 4. Small indeterminate splenic hypodensity. Grade 1 injury is difficult to exclude but thought less likely. There is no perisplenic free fluid. Attention on follow-up. 5. Lytic lesion/lack of ossification involving the sternum and xiphoid process, of uncertain etiology. This could be due to lack of cartilaginous ossification/developmental. However, clinical correlation and follow-up recommended. 6. No acute fracture or dislocation of the thoracic or lumbar spine. 7. Additional findings above.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There are scattered groundglass opacities seen within the left upper and lower lobes with a suspected trace anterior left pneumothorax. No pleural effusion.. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: There is a small indeterminate hypodensity seen within the spleen on image 205, series 501, technically indeterminate but thought less likely related to trauma. There is no perisplenic free fluid. ADRENALS: Normal. KIDNEYS: There is a small linear hypodensity seen in the upper pole of the left kidney which is technically indeterminate seen best on coronal image 67, series 503.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is a mildly displaced fracture of the left superior and inferior pubic ramus. There is a mildly displaced acute zone 2 fracture of the left sacrum involving the left S1, S2, and probably S3 neuroforamen. There is a mildly displaced fracture of the left iliac wing that involves the left SI joint with minimal left SI joint diastases. There is lucency/cortical absence seen within the superior sternum without associated soft tissue mass, indeterminate. Bilateral os acromiale are noted. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: SINOCRANIAL AND SINOORBITAL JUNCTIONS: The bones adjacent to the sinuses, including the lamina papyracea, cribriform plates and fovea ethmoidalis, are intact. There is Keros anatomy type I bilaterally. NASAL SEPTUM/NASAL CAVITY: There is mild left-sided deviation involving the nasal septum. FRONTAL SINUSES, DRAINAGE PATHWAYS, AND ASSOCIATED ANATOMIC VARIANTS: The frontal sinuses are well developed and aerated. The frontal recesses are free of mucosal disease. ETHMOID SINUSES: Minimal mucosal thickening of left ethmoidal air cell. SPHENOID SINUSES, DRAINAGE PATHWAYS, AND ASSOCIATED VARIANTS: Minimal mucosal thickening of the right sphenoidal sinus. The intersinus septum inserts to the right carotid canal. The carotid canals are covered by bone. MAXILLARY SINUSES, DRAINAGE PATHWAYS, AND ASSOCIATED VARIANTS: There is mild mucosal thickening involving the bilateral maxillary sinuses. There is a retention cyst in left maxillary sinus. OMCs are occluded. MASTOID AIR CELLS: The mastoid air cells are well developed and aerated. Brain: Limited evaluation of the brain parenchyma is unremarkable. ORBITS: The globes, preseptal spaces, intraconal and extraconal spaces appear unremarkable without obvious space-occupying lesion or inflammation. There are vertical muscular bands between the temporal portion of the superior rectus muscles to temporal portion of the inferior rectus muscle bilaterally most consistent with supernumerary extraocular muscles. Restrictive strabismus has been reported secondary to this variation.
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2,784
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RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From Reformat 3-D CT MIP and Volume rendered angiographic images were generated in post processing. Patient weight: 116 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 234 mm. DLP: 916.70 mGy cm. STRUCTURED REPORT: CT Angiogram Neck FINDINGS: AORTIC ARCH and PROXIMAL GREAT VESSELS: The left common carotid branches off of the brachiocephalic arteries. Otherwise, unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. STRUCTURED REPORT: CT Cervical Spine Trauma FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: AORTIC ARCH and PROXIMAL GREAT VESSELS: The left common carotid branches off of the brachiocephalic arteries. Otherwise, unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. STRUCTURED REPORT: CT Cervical Spine Trauma FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral subpleural, basilar predominant reticulations with probable honeycombing at the left lung base. There is associated volume loss and traction bronchiectasis. There are multiple bilateral pulmonary nodules the largest measuring 9 mm in the left upper lobe lingula on series 2 image 138. There is no focal consolidation, pleural effusion, or pneumothorax. With expiration, no marked air trapping. Central airways are patent. HEART / VESSELS: Heart size is normal. No pericardial effusion. Moderate atherosclerotic calcifications of the thoracic aorta. Severe coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. Patulous esophagus. LYMPH NODES: Prominent lymph nodes in the mediastinum, none significant enlarged. CHEST WALL: Left chest wall loop recorder. UPPER ABDOMEN: Normal noncontrast appearance of the imaged upper abdomen. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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2,785
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 116 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. DLP: 577.50 mGy cm. (accession CT220003314), Patient weight: 116 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. (accession CT220003315) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There are scattered groundglass opacities seen within the left upper and lower lobes with a suspected trace anterior left pneumothorax. No pleural effusion.. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: There is a small indeterminate hypodensity seen within the spleen on image 205, series 501, technically indeterminate but thought less likely related to trauma. There is no perisplenic free fluid. ADRENALS: Normal. KIDNEYS: There is a small linear hypodensity seen in the upper pole of the left kidney which is technically indeterminate seen best on coronal image 67, series 503.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is a mildly displaced fracture of the left superior and inferior pubic ramus. There is a mildly displaced acute zone 2 fracture of the left sacrum involving the left S1, S2, and probably S3 neuroforamen. There is a mildly displaced fracture of the left iliac wing that involves the left SI joint with minimal left SI joint diastases. There is lucency/cortical absence seen within the superior sternum without associated soft tissue mass, indeterminate. Bilateral os acromiale are noted. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Left sacral fracture. Left superior and inferior pubic rami fracture. Left iliac bone fracture involving the left SI joint which minimal left SI joint diastases. 2. Multifocal left pulmonary contusions with trace left pneumothorax. No definite rib fracture identified. 3. Indeterminate linear hypodensity in the upper pole left kidney. A tiny grade 2 splenic injury cannot be entirely excluded. 4. Small indeterminate splenic hypodensity. Grade 1 injury is difficult to exclude but thought less likely. There is no perisplenic free fluid. Attention on follow-up. 5. Lytic lesion/lack of ossification involving the sternum and xiphoid process, of uncertain etiology. This could be due to lack of cartilaginous ossification/developmental. However, clinical correlation and follow-up recommended. 6. No acute fracture or dislocation of the thoracic or lumbar spine. 7. Additional findings above.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There are scattered groundglass opacities seen within the left upper and lower lobes with a suspected trace anterior left pneumothorax. No pleural effusion.. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: There is a small indeterminate hypodensity seen within the spleen on image 205, series 501, technically indeterminate but thought less likely related to trauma. There is no perisplenic free fluid. ADRENALS: Normal. KIDNEYS: There is a small linear hypodensity seen in the upper pole of the left kidney which is technically indeterminate seen best on coronal image 67, series 503.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is a mildly displaced fracture of the left superior and inferior pubic ramus. There is a mildly displaced acute zone 2 fracture of the left sacrum involving the left S1, S2, and probably S3 neuroforamen. There is a mildly displaced fracture of the left iliac wing that involves the left SI joint with minimal left SI joint diastases. There is lucency/cortical absence seen within the superior sternum without associated soft tissue mass, indeterminate. Bilateral os acromiale are noted. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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FINDINGS: BONES/JOINTS: Lateral fixation plate and screws of the proximal humeral shaft without evidence of hardware loosening or failure. There has been interval healing of the transverse fracture through the proximal humeral metaphysis with extension through the greater tuberosity. Glenohumeral and acromioclavicular joint spaces are well-maintained with mild degenerative changes. There is a small ossific density anterior to the medial humeral head (series 301 image 16) is likely secondary to prior trauma. SOFT TISSUES: No large hematoma or fluid collection. No appreciable atrophy of the rotator cuff muscles.
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2,786
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EXAM: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat CLINICAL INFORMATION: COMPARISON: None. TECHNIQUE: CT Chest with contrast, CT Abdomen and Pelvis w contrast, CT Lumbar Spine from Reformat, CT Thoracic Spine from Reformat. Patient weight: 116 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. DLP: 577.50 mGy cm. (accession CT220003314), Patient weight: 116 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 415 mm. (accession CT220003315) FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There are scattered groundglass opacities seen within the left upper and lower lobes with a suspected trace anterior left pneumothorax. No pleural effusion.. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: There is a small indeterminate hypodensity seen within the spleen on image 205, series 501, technically indeterminate but thought less likely related to trauma. There is no perisplenic free fluid. ADRENALS: Normal. KIDNEYS: There is a small linear hypodensity seen in the upper pole of the left kidney which is technically indeterminate seen best on coronal image 67, series 503.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is a mildly displaced fracture of the left superior and inferior pubic ramus. There is a mildly displaced acute zone 2 fracture of the left sacrum involving the left S1, S2, and probably S3 neuroforamen. There is a mildly displaced fracture of the left iliac wing that involves the left SI joint with minimal left SI joint diastases. There is lucency/cortical absence seen within the superior sternum without associated soft tissue mass, indeterminate. Bilateral os acromiale are noted. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. CONCLUSION: 1. Left sacral fracture. Left superior and inferior pubic rami fracture. Left iliac bone fracture involving the left SI joint which minimal left SI joint diastases. 2. Multifocal left pulmonary contusions with trace left pneumothorax. No definite rib fracture identified. 3. Indeterminate linear hypodensity in the upper pole left kidney. A tiny grade 2 splenic injury cannot be entirely excluded. 4. Small indeterminate splenic hypodensity. Grade 1 injury is difficult to exclude but thought less likely. There is no perisplenic free fluid. Attention on follow-up. 5. Lytic lesion/lack of ossification involving the sternum and xiphoid process, of uncertain etiology. This could be due to lack of cartilaginous ossification/developmental. However, clinical correlation and follow-up recommended. 6. No acute fracture or dislocation of the thoracic or lumbar spine. 7. Additional findings above.
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: There are scattered groundglass opacities seen within the left upper and lower lobes with a suspected trace anterior left pneumothorax. No pleural effusion.. HEART / VESSELS: No significant abnormality. MEDIASTINUM / ESOPHAGUS: Residual thymic tissue is noted. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: There is a small indeterminate hypodensity seen within the spleen on image 205, series 501, technically indeterminate but thought less likely related to trauma. There is no perisplenic free fluid. ADRENALS: Normal. KIDNEYS: There is a small linear hypodensity seen in the upper pole of the left kidney which is technically indeterminate seen best on coronal image 67, series 503.. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: No significant abnormality. MUSCULOSKELETAL: There is a mildly displaced fracture of the left superior and inferior pubic ramus. There is a mildly displaced acute zone 2 fracture of the left sacrum involving the left S1, S2, and probably S3 neuroforamen. There is a mildly displaced fracture of the left iliac wing that involves the left SI joint with minimal left SI joint diastases. There is lucency/cortical absence seen within the superior sternum without associated soft tissue mass, indeterminate. Bilateral os acromiale are noted. THORACIC SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal. LUMBAR SPINE: VERTEBRA: No fracture. DISC SPACES AND FACET JOINTS: No acute injury. PREVERTEBRAL SOFT TISSUES: Normal. ALIGNMENT: Normal.
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Findings: Lines and Tubes: 3-lead pacing device. Body Wall and Abdomen: No destructive osseous lesions. Included portions of the upper abdomen have an unremarkable appearance. Lymph Nodes, Mediastinum and Neck: No axillary adenopathy. No mediastinal adenopathy. Lungs and Pleura: Moderate-advanced destructive centrilobular emphysema. Mild paraseptal emphysema. There is moderate left lower lobe volume loss associated with left lower lobe round atelectasis, pleural thickening, and extrapleural fatty proliferation. Mild bronchiectasis. Right apical nodule image 48 series 2 likely represents a region of scarring and is unchanged demonstrating a relatively flat appearance on coronally reformatted images. Cardiovascular: Heart size is normal. Dense coronary artery atherosclerotic calcifications. No large pericardial effusion.
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2,787
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RADIOLOGIC EXAM: CT Head wo contrast, CT Maxillofacial wo contrast CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Head wo contrast, CT Maxillofacial wo contrastScan field of view: 279 mm. DLP: 1444 mGy cm. (accession CT220003313), Scan field of view: 220 mm. DLP: 1049.70 mGy cm. (accession CT220003319) FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture evident. Ununited appearance of the anterior and posterior arch of C1, developmental. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL CT: Age indeterminate bilateral nasal bone irregularity. No nasal septal abnormality. No additional facial fractures. Orbits appear maintained. The globes are intact. The mandible is intact. The TMJs are appropriately positioned. There are impacted bilateral maxillary and mandibular molars. Several dental caries and a chronically absent appearing right maxillary molar. Soft tissue contusive changes at the left face peripheral to the left zygomatic arch. CONCLUSION: 1. No acute intracranial process. 2. Age indeterminate nasal bone fractures. Otherwise, no acute maxillofacial fractures evident. 3. Left sided facial contusive changes.
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FINDINGS: BRAIN PARENCHYMA: No hemorrhage, mass effect or edema. EXTRA-AXIAL SPACES: Normal. SKULL AND SKULL BASE: No acute fracture evident. Ununited appearance of the anterior and posterior arch of C1, developmental. VENTRICULAR SYSTEM: Normal. ORBITS: Normal. SINUSES: Normal. MAXILLOFACIAL CT: Age indeterminate bilateral nasal bone irregularity. No nasal septal abnormality. No additional facial fractures. Orbits appear maintained. The globes are intact. The mandible is intact. The TMJs are appropriately positioned. There are impacted bilateral maxillary and mandibular molars. Several dental caries and a chronically absent appearing right maxillary molar. Soft tissue contusive changes at the left face peripheral to the left zygomatic arch.
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FINDINGS: STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Bilateral basilar predominant groundglass opacities are overall stable compared to prior examination, centrally located. Stable appearance of left upper lobe pleural-based nodule measuring 0.9 x 0.6 m on series 2 image 97, previously 0.8 x 0.7 cm. No new suspicious pulmonary nodule is identified. No pleural effusion or pneumothorax. HEART / VESSELS: Heart size is normal. No pericardial effusion. Mild coronary artery calcifications. MEDIASTINUM / ESOPHAGUS: Small hiatal hernia. Circumferential thickening of the distal esophagus. LYMPH NODES: Similar appearance of prominent mediastinal and bilateral hilar lymph nodes with a pretracheal lymph node measuring up to 1.5 cm in short axis diameter, stable compared to prior examination. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Normal noncontrast appearance of the imaged upper abdomen. MUSCULOSKELETAL: No acute or aggressive appearing osseous abnormality.
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2,788
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RADIOLOGIC EXAM: CT Angio Neck, CT Cervical Spine From Reformat CLINICAL INFORMATION: Trauma. COMPARISON: None. TECHNIQUE: CT Angio Neck, CT Cervical Spine From Reformat 3-D CT MIP and Volume rendered angiographic images were generated in post processing. Patient weight: 116 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 80 ml. IV contrast injection rate: 3.50 ml per sec. Scan delay: bolus tracked Scan field of view: 234 mm. DLP: 916.70 mGy cm. STRUCTURED REPORT: CT Angiogram Neck FINDINGS: AORTIC ARCH and PROXIMAL GREAT VESSELS: The left common carotid branches off of the brachiocephalic arteries. Otherwise, unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. STRUCTURED REPORT: CT Cervical Spine Trauma FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: AORTIC ARCH and PROXIMAL GREAT VESSELS: The left common carotid branches off of the brachiocephalic arteries. Otherwise, unremarkable. RIGHT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT CAROTID: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. RIGHT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. LEFT VERTEBRAL ARTERY: There is no evidence of irregularity, narrowing, occlusion or flap to indicate acute arterial injury or dissection. No contrast extravasation or pseudoaneurysm is identified. STRUCTURED REPORT: CT Cervical Spine Trauma FINDINGS: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT PE OVERALL DIAGNOSTIC QUALITY: Mildly suboptimal quality with incomplete evaluation of subsegmental pulmonary arteries. LOWER NECK: No abnormality. CHEST: PULMONARY ARTERIES: Negative for pulmonary embolus LUNGS / AIRWAYS / PLEURA: Right lower lobe calcified granulomas. No focal consolidation, pneumothorax, or pleural effusion. HEART / OTHER VESSELS: Normal heart size. No pericardial effusion. Bovine arch. Mild calcified atherosclerosis of the thoracic aorta. MEDIASTINUM / ESOPHAGUS: Normal. LYMPH NODES: Scattered calcified lymph nodes, likely sequela of prior granulomatous disease. CHEST WALL: Surgical clips in the left axilla and breast. UPPER ABDOMEN: Splenic calcified granulomas. Cholecystectomy changes. MUSCULOSKELETAL: Mild multilevel discogenic degenerative change of the thoracic spine. Diffuse osseous demineralization.
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2,789
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EXAM: CT Angio Lower Ext Bil wo+w contrast CLINICAL INFORMATION: COMPARISON: None. TECHNIQUE: CT Angio Lower Ext Bil wo+w contrast. Additional 3D image post-processing was performed to generate MIP and/or volume-rendered images. Patient weight: 157 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: bolus track Scan field of view: 360 mm. DLP: 1469.56 mGy cm. FINDINGS: STRUCTURED REPORT: CTA Lower Extremities VASCULATURE: Mild scattered atherosclerotic calcification throughout the arterial system. Scattered areas of circumferential calcification of the arteries of the lower extremity. This significantly limits evaluation of the below the knee vessel patency. ABDOMINAL AORTA: No significant abnormality. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: Circumferential calcification of the distal superficial femoral artery and proximal popliteal artery with no significant associated stenosis. RIGHT TIBIAL AND PERONEAL ARTERIES: Circumferential calcification of the anterior and posterior tibial arteries limits evaluation for patency. The peroneal artery is patent to the ankle. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Circumferential calcification of the mid to distal superficial femoral artery and proximal popliteal artery with no associated stenosis. LEFT TIBIAL AND PERONEAL ARTERIES: Circumferential calcification of the posterior tibial and peroneal arteries makes evaluation for patency difficult but grossly appear patent. The anterior tibial artery demonstrates surgical residual calcification in both distally and proximally but is grossly patent. ------------------------------------------------------------- LOWER CHEST: Mild bronchiectasis in the lung bases of unknown clinical significance. 7 mm pulmonary nodule in the right lung base (series 4/image 111). ABDOMEN and PELVIS: LIVER: Ill-defined hypodensity in the dome of the liver measuring 1.9 x 1.9 x 2.3 cm. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No lymph node enlargement. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small bilateral fat-containing inguinal hernias. MUSCULOSKELETAL: Scattered sclerotic/destructive lesion seen throughout the skeleton, which is most pronounced in the L1 vertebral body, sacrum, and left ischial ramus. CONCLUSION: Scattered atherosclerotic disease as described above. Evaluation of lower leg arteries is limited due to circumference atherosclerotic calcification. Several sclerotic/destructive lesions seen throughout the skeleton, which are most pronounced in the L1 vertebral body, sacrum, and left ischial ramus. There is also a 2.3 cm ill-defined hypodensity seen in the dome of the liver and a 7 mm pulmonary nodule in the right lower lobe. These findings should be correlated with known findings associated with the reported history of breast cancer.
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FINDINGS: STRUCTURED REPORT: CTA Lower Extremities VASCULATURE: Mild scattered atherosclerotic calcification throughout the arterial system. Scattered areas of circumferential calcification of the arteries of the lower extremity. This significantly limits evaluation of the below the knee vessel patency. ABDOMINAL AORTA: No significant abnormality. RIGHT ILIAC ARTERIES: No significant abnormality. RIGHT FEMORAL \T\ POPLITEAL ARTERIES: Circumferential calcification of the distal superficial femoral artery and proximal popliteal artery with no significant associated stenosis. RIGHT TIBIAL AND PERONEAL ARTERIES: Circumferential calcification of the anterior and posterior tibial arteries limits evaluation for patency. The peroneal artery is patent to the ankle. LEFT ILIAC ARTERIES: No significant abnormality. LEFT FEMORAL \T\ POPLITEAL ARTERIES: Circumferential calcification of the mid to distal superficial femoral artery and proximal popliteal artery with no associated stenosis. LEFT TIBIAL AND PERONEAL ARTERIES: Circumferential calcification of the posterior tibial and peroneal arteries makes evaluation for patency difficult but grossly appear patent. The anterior tibial artery demonstrates surgical residual calcification in both distally and proximally but is grossly patent. ------------------------------------------------------------- LOWER CHEST: Mild bronchiectasis in the lung bases of unknown clinical significance. 7 mm pulmonary nodule in the right lung base (series 4/image 111). ABDOMEN and PELVIS: LIVER: Ill-defined hypodensity in the dome of the liver measuring 1.9 x 1.9 x 2.3 cm. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Normal. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: No abnormality. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: No lymph node enlargement. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: No abnormality. BODY WALL: Small bilateral fat-containing inguinal hernias. MUSCULOSKELETAL: Scattered sclerotic/destructive lesion seen throughout the skeleton, which is most pronounced in the L1 vertebral body, sacrum, and left ischial ramus.
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FINDINGS: Scouts: No additional findings. Lines and tubes: Right IJ catheter terminates in the right atrium as before. Left anterior chest wall loop recorder Lungs and pleura: Linear atelectasis/scarring in both lower, right middle lobes and lingula is overall unchanged. No pulmonary consolidation. No suspicious pulmonary nodules. Small left pleural effusion is present. No pneumothorax. Esophagus, Mediastinum and neck: Esophagus is normal. Redemonstration of periaortic fluid collection showing interval decrease in size on comparison, now approximately measuring 17 x 59 mm (series 3 image 43), previously 91 x 16 mm, with interval decrease in internal gas foci. The thyroid gland is normal. Lymph Nodes: None enlarged. Cardiovascular: Biatrial dilation. Postsurgical changes from prior ascending aortic repair with periaortic fluid collection as described above. Small pericardial effusion is present. Mild aortic valvular calcifications. Mildly dilated descending thoracic aorta Coronary artery atherosclerotic calcification: None detected. Abdomen: No upper abdominal abnormality identified. Musculoskeletal/Body Wall: Redemonstration of postsurgical changes from prior median sternotomy in the anterior chest wall in the midline. No definite drainable fluid collection in the anterior chest wall. Mild diffuse anasarca. Surgical staples in the right lateral chest wall. Intact median sternotomy wires with increased sternal separation at the level of the top two sternotomy wires on comparison. Partially healed fracture involving bilateral second ribs anterolaterally Degenerative changes in spine.
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2,790
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EXAM: CT Neck Soft Tissue w contrast CLINICAL INFORMATION: Female patient 69 years with jaw necrosis, M87.9 Osteonecrosis, unspecified. History of breast cancer with medically related osteonecrosis of the jaw status post ZOMETA use. Status post excision of right mandible lesion and also facial abscess TECHNIQUE: 1.25 mm thick serial axial images were obtained through the neck without intravenous contrast. Sagittal and coronal reformatted views were also obtained. Technologist stated no intravenous access could be obtained. Technique: Patient weight: 157 lbs. IV contrast: Omnipaque 350, 115 ml, per protocol. Saline flush: 20 ml. IV contrast injection rate: 2.50 ml per sec. Scan delay: 0 sec. Scan field of view: 240 mm. DLP: 738.09 mGy cm. COMPARISON: None available. FINDINGS: There is focal bone defect involving the right mandibular body. There is significant cortical destruction both medially and laterally and there is focal destruction of the alveolar ridge of the right mandible. The defect extends to the lateral margin of the right lateral mandibular incisor. There is irregular sclerotic density within the bony defect measuring approximately 4 x 1.3 x 2.5 cm. There is diffuse focal contiguity with the native mandible along the medial and anterior and inferior aspect there is mostly lucency at the sclerotic density and mandible interface. There is significant sclerosis and periosteal thickening of the adjacent right mandibular body and also involving the anterior left mandible. There is also adjacent soft tissue thickening laterally greater than medially. Irregular soft tissue attenuation along the inferior aspect of the right mandibular body extends to the skin surface laterally possibly representing focal site of drainage There is also small amount of gas within the soft tissues. No fluid collection is identified on these noncontrast images. No lesion is identified within the nasopharynx, oropharynx or hypopharynx. Larynx appears unremarkable. There are small submental lymph nodes bilaterally. There are also shotty lymph nodes within the internal jugular chains bilaterally. These are likely reactive. The parotid glands and submandibular glands appear within normal limits. There is no focal destructive osseous lesion. There are mild to moderate atherosclerotic calcifications of the left carotid bifurcation and only mild atherosclerotic calcifications of the right carotid bifurcation Within the right chest wall there is suggestion of focal thickening on the inferior most images involving the lateral most visualized portion of the right pectoralis muscle of uncertain clinical significance. CONCLUSION: 01. Osseous defect involving the right mandibular body with bone graft/methylmethacrylate cement spacer within the defect without incorporation. There is diffuse adjacent sclerosis of the mandible which is expanded suggesting chronic osteomyelitis. It would be difficult to exclude underlying osteonecrosis. 02. Soft tissue swelling about the right mandible with extension to the skin which may represent a sinus tract. No drainable fluid collection is identified on this noncontrast examination 03. Shotty submental and bilateral internal jugular chain lymph nodes. 04. Questionable focal soft tissue thickening involving the visualized most lateral portion of the right pectoralis major muscle of uncertain clinical significance.
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FINDINGS: There is focal bone defect involving the right mandibular body. There is significant cortical destruction both medially and laterally and there is focal destruction of the alveolar ridge of the right mandible. The defect extends to the lateral margin of the right lateral mandibular incisor. There is irregular sclerotic density within the bony defect measuring approximately 4 x 1.3 x 2.5 cm. There is diffuse focal contiguity with the native mandible along the medial and anterior and inferior aspect there is mostly lucency at the sclerotic density and mandible interface. There is significant sclerosis and periosteal thickening of the adjacent right mandibular body and also involving the anterior left mandible. There is also adjacent soft tissue thickening laterally greater than medially. Irregular soft tissue attenuation along the inferior aspect of the right mandibular body extends to the skin surface laterally possibly representing focal site of drainage There is also small amount of gas within the soft tissues. No fluid collection is identified on these noncontrast images. No lesion is identified within the nasopharynx, oropharynx or hypopharynx. Larynx appears unremarkable. There are small submental lymph nodes bilaterally. There are also shotty lymph nodes within the internal jugular chains bilaterally. These are likely reactive. The parotid glands and submandibular glands appear within normal limits. There is no focal destructive osseous lesion. There are mild to moderate atherosclerotic calcifications of the left carotid bifurcation and only mild atherosclerotic calcifications of the right carotid bifurcation Within the right chest wall there is suggestion of focal thickening on the inferior most images involving the lateral most visualized portion of the right pectoralis muscle of uncertain clinical significance.
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FINDINGS: The left chest tube is traversing in the left major fissure as before. There is a small dependent left partly loculated pleural effusion, adjacent atelectasis and nondependent left pneumothorax at the apex extending along the upper mediastinal pleura. The right-sided effusion has significantly decreased without any right pneumothorax noted. Interval reexpansion of the right lower lobe. Interval improvement in right upper lobe lung laceration with few nodular changes better seen in the right upper and lower lobe on today's scan. There are few new subpleural groundglass parenchymal changes in the right upper lobe. Only small subcentimeter size nodes are seen in the mediastinum. Multiple displaced anterior rib fractures with associated surrounding extrapleural hematoma, few left rib fractures have been internally fixed.
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2,791
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EXAM: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP images were generated in post processing. Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003325), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003327), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003328), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. DLP: 1276.70 mGy cm. (accession CT220003324) FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: Lines and Tubes: None. Body Wall and Abdomen: No destructive osseous lesions. Included portions of the upper abdomen have an unremarkable appearance. Lymph Nodes, Mediastinum and Neck: No axillary or mediastinal adenopathy. Lungs and Pleura: No pleural effusion. Mild bronchial wall thickening. Tiny subpleural middle lobe nodule image 63 series 2. Tiny left lower lobe nodule image 86. No subpleural reticulation. Cardiovascular: Heart size is normal. Relatively low density blood pool. No pericardial effusion.
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2,792
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EXAM: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP images were generated in post processing. Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003325), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003327), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003328), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. DLP: 1276.70 mGy cm. (accession CT220003324) FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT Abdomen Pelvis LOWER CHEST: LUNG BASES / PLEURA: Normal. DISTAL ESOPHAGUS: Normal. HEART / VESSELS: No significant abnormality. ABDOMEN and PELVIS: LIVER: Normal. BILIARY TRACT: Normal. GALLBLADDER: No abnormality. PANCREAS: Normal. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Subcentimeter focus of hypoattenuation in the right upper pole is too small for accurate characterization. LYMPH NODES: There are multiple enlarged mesorectal and iliac chain lymph nodes, for example right internal iliac lymph node measures 1 x 1 cm on image 245 series 2. An example prominent mesorectal lymph node measures 0.6 x 0.5 cm on image 97 series 2. STOMACH / SMALL BOWEL: No abnormality. COLON / APPENDIX: Ill-defined, lobular rectal mass measures 4.8 x 3.8 cm in greatest axial dimensions on image 314 series 2. The lesion may involve the anorectal junction and measures up to 7.8 cm in greatest craniocaudal extent on image 193 series 602. Metallic attenuating structures in the proximal sigmoid colon. Normal appendix. PERITONEUM / MESENTERY: Normal. RETROPERITONEUM: Normal. VESSELS: Minimal atherosclerotic calcifications of the abdominal aorta and branch vessels. URINARY BLADDER: Normal. REPRODUCTIVE ORGANS: Prostate gland is enlarged. BODY WALL: No significant abnormality. MUSCULOSKELETAL: Sclerotic lesion in the left iliac bone measures up to 2.0 cm on image 240 series 2. No destructive osseous lesions seen.
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2,793
|
EXAM: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP images were generated in post processing. Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003325), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003327), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003328), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. DLP: 1276.70 mGy cm. (accession CT220003324) FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: BRAIN PARENCHYMA: No acute intracranial hemorrhage, midline shift, or edema. Noncalcified, dural based lesion adjacent to the right frontal lobe measuring 9.3 x 8.4 mm (image 48, series 201). There is associated remodeling of the inner table of the skull. Gray-white matter differentiation is maintained. Mild diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Mild ex vacuo ventriculomegaly. ORBITS: Fracture of the right lamina papyracea with herniation of fat. The extraocular muscles are normal. Bilateral lens replacements. SKULL AND SKULL BASE: No skull base fracture is detected. Fat-containing lesion in the sphenoid likely represents intraosseous lipoma. FACIAL BONES: No definite acute fracture. MANDIBLE: Normal. Temporomandibular joints are normally aligned. Scattered dental caries. Torus palatini. SINONASAL CAVITIES: Opacification of the right maxillary sinus with hyperdense inspissated contents and mild osteitis. Mildly displaced, comminuted type II fracture of the dens.
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2,794
|
EXAM: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP images were generated in post processing. Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003325), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003327), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003328), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. DLP: 1276.70 mGy cm. (accession CT220003324) FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Subcentimeter left thyroid nodule. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered bilateral atelectasis. No pleural effusion or pneumothorax. The central airways are patent. HEART / VESSELS: The heart is mildly enlarged. There are calcifications of the mitral valve annulus. The pulmonary artery is enlarged measuring 3.6 cm. There is a left lower lobe segmental pulmonary artery filling defect (series 501#132-135). MEDIASTINUM / ESOPHAGUS: No significant mediastinal hematoma. There is a small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture. ABDOMEN and PELVIS: LIVER: No suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Pancreatic steatosis. SPLEEN: Unremarkable. ADRENALS: Normal. KIDNEYS: No hydronephrosis or suspicious mass. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: There are postoperative changes of the stomach. There is fatty metaplasia in the stomach. The loops of small bowel are normal in caliber COLON / APPENDIX: Colonic diverticulosis. The appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcified atherosclerotic disease. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: There is post hysterectomy. BODY WALL: No significant acute abnormality. MUSCULOSKELETAL: A suture anchor is noted in the right humeral head. There are degenerative changes of spine. There is an anterior compression deformity L2 vertebral body with
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2,795
|
EXAM: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP images were generated in post processing. Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003325), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003327), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003328), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. DLP: 1276.70 mGy cm. (accession CT220003324) FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: STRUCTURED REPORT: CT CAP Trauma LOWER NECK: Subcentimeter left thyroid nodule. CHEST: LUNGS / AIRWAYS / PLEURA: Scattered bilateral atelectasis. No pleural effusion or pneumothorax. The central airways are patent. HEART / VESSELS: The heart is mildly enlarged. There are calcifications of the mitral valve annulus. The pulmonary artery is enlarged measuring 3.6 cm. There is a left lower lobe segmental pulmonary artery filling defect (series 501#132-135). MEDIASTINUM / ESOPHAGUS: No significant mediastinal hematoma. There is a small hiatal hernia. DIAPHRAGM: Intact. LYMPH NODES: None enlarged. CHEST WALL: No acute displaced rib, clavicle or sternal fracture. ABDOMEN and PELVIS: LIVER: No suspicious lesion. BILIARY TRACT: Normal. GALLBLADDER: Cholelithiasis. PANCREAS: Pancreatic steatosis. SPLEEN: Unremarkable. ADRENALS: Normal. KIDNEYS: No hydronephrosis or suspicious mass. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: There are postoperative changes of the stomach. There is fatty metaplasia in the stomach. The loops of small bowel are normal in caliber COLON / APPENDIX: Colonic diverticulosis. The appendix appears unremarkable. PERITONEUM / MESENTERY: No free air or free fluid. RETROPERITONEUM: Normal. VESSELS: Mild scattered calcified atherosclerotic disease. URINARY BLADDER: Unremarkable. REPRODUCTIVE ORGANS: There is post hysterectomy. BODY WALL: No significant acute abnormality. MUSCULOSKELETAL: A suture anchor is noted in the right humeral head. There are degenerative changes of spine. There is an anterior compression deformity L2 vertebral body with
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2,796
|
EXAM: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP images were generated in post processing. Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003325), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003327), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003328), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. DLP: 1276.70 mGy cm. (accession CT220003324) FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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2,797
|
EXAM: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck CLINICAL INFORMATION: Trauma COMPARISON: None. TECHNIQUE: CT Abdomen and Pelvis w contrast, CT Thoracic Spine from Reformat, CT Lumbar Spine from Reformat, CT Chest with contrast, CT Head wo contrast, CT Cervical Spine From Reformat, CT Angio Neck 3-D CT MIP images were generated in post processing. Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003325), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003327), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. (accession CT220003328), Patient weight: 175 lbs. IV contrast: Omnipaque 350, 120 ml, per protocol. Saline flush: 100 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 455 mm. DLP: 1276.70 mGy cm. (accession CT220003324) FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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FINDINGS: HEAD: The gray-white matter differentiation is intact. There is no evidence of acute infarct, hemorrhage, mass or mass effect. The ventricular system and extra-axial spaces appear normal. No calvarial fracture is identified. CERVICAL SPINE: SKULL BASE AND CERVICOCRANIAL JUNCTION: Visualized portions of skull base including occipital bone and occipital condyles are normal. No evidence of skull base fracture. ATLANTODENTAL INTERVAL: Normal (
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Findings: CT T-spine: Ankylosis is seen at least from T5 through T10. The thoracic vertebrae are normally formed and aligned. No fracture or subluxation is seen. Bone texture is normal with no lytic or blastic lesion. The spinal canal has normal dimensions with no encroachment. See the chest CT for pulmonary and cardiac findings. CT L-spine: There is slight compression of the upper endplate of L2 which appears remote with no visible fracture line and there are circumferential osteophytes. No recent fracture or subluxation is seen. There is no apparent disc defect and no canal stenosis. There is degenerative disc disease at L5 1 with loss of height and dense sclerosis in adjacent endplates. There is severe facet arthropathy at L4-5 and L5-1. There is slight neuroforaminal stenosis bilaterally bilaterally at L5-1. The marrow spaces and paraspinal soft tissues are unremarkable. ---------------
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2,798
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EXAM: CT Chest wo contrast CLINICAL INFORMATION: 10 pack-year smoking history and intractable hiccups. Further evaluate small right lower lobe nodule on chest radiograph. COMPARISON: Chest radiograph 12/17/2021 TECHNIQUE: CT Chest wo contrast. Scan field of view: 350 mm. DLP: 176.52 mGy cm. FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Respiratory motion limits evaluation the lung bases. Calcified bilateral lower lobe granulomas. Calcified granuloma in the RLL on series 2 image 191 corresponds to the nodule seen on chest radiograph. Small nodules in the right major fissure measuring up to 6 mm (series 2, image 141), possibly perifissural lymph nodes. Small 3 mm nodule in the left upper lobe (series 2, image 144) and 2 mm nodule in the left lower lobe (series 2, image 159). With additional tiny peripheral LUL nodule on image 80. No pleural effusion. HEART / VESSELS: The heart is normal in size without pericardial effusion. Mild coronary artery atherosclerotic calcifications. The thoracic aorta and pulmonary arteries are normal in caliber. MEDIASTINUM / ESOPHAGUS: The esophagus is patulous with ingested contents/fluid and gas in the mildly distended lumen. LYMPH NODES: Calcified mediastinal and right hilar lymph nodes. No enlarged intrathoracic lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Circumscribed fat density abuts the posterior gastric antral wall measuring 1.3 x 1.0 cm (series 2, image 246). MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel degenerative changes of the thoracic spine. CONCLUSION: 1. Small left lung nodules measuring up to 3 mm. Two right-sided fissural nodules measuring up to 4 mm. According to the most recent Fleischner Society Pulmonary Nodule Guidelines, 1-year CT follow-up is recommended. Calcified granulomas in the bilateral lower lobes. [Calcified granuloma in the RLL corresponds to the nodule seen on chest radiograph] 2. Patulous esophagus with ingested contents/fluid can be seen with gastroesophageal reflex or esophageal dysmotility. Recommend further evaluation with outpatient barium swallow if clinically indicated. 3. Circumscribed fat density in the posterior antral wall of the stomach may represent gastric lipoma versus adherent ingested content. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT Chest LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: The central airways are patent. Respiratory motion limits evaluation the lung bases. Calcified bilateral lower lobe granulomas. Calcified granuloma in the RLL on series 2 image 191 corresponds to the nodule seen on chest radiograph. Small nodules in the right major fissure measuring up to 6 mm (series 2, image 141), possibly perifissural lymph nodes. Small 3 mm nodule in the left upper lobe (series 2, image 144) and 2 mm nodule in the left lower lobe (series 2, image 159). With additional tiny peripheral LUL nodule on image 80. No pleural effusion. HEART / VESSELS: The heart is normal in size without pericardial effusion. Mild coronary artery atherosclerotic calcifications. The thoracic aorta and pulmonary arteries are normal in caliber. MEDIASTINUM / ESOPHAGUS: The esophagus is patulous with ingested contents/fluid and gas in the mildly distended lumen. LYMPH NODES: Calcified mediastinal and right hilar lymph nodes. No enlarged intrathoracic lymph nodes. CHEST WALL: No significant abnormality. UPPER ABDOMEN: Circumscribed fat density abuts the posterior gastric antral wall measuring 1.3 x 1.0 cm (series 2, image 246). MUSCULOSKELETAL: No aggressive osseous lesions. Mild multilevel degenerative changes of the thoracic spine.
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Findings: CT T-spine: Ankylosis is seen at least from T5 through T10. The thoracic vertebrae are normally formed and aligned. No fracture or subluxation is seen. Bone texture is normal with no lytic or blastic lesion. The spinal canal has normal dimensions with no encroachment. See the chest CT for pulmonary and cardiac findings. CT L-spine: There is slight compression of the upper endplate of L2 which appears remote with no visible fracture line and there are circumferential osteophytes. No recent fracture or subluxation is seen. There is no apparent disc defect and no canal stenosis. There is degenerative disc disease at L5 1 with loss of height and dense sclerosis in adjacent endplates. There is severe facet arthropathy at L4-5 and L5-1. There is slight neuroforaminal stenosis bilaterally bilaterally at L5-1. The marrow spaces and paraspinal soft tissues are unremarkable. ---------------
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2,799
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EXAM: CT Chest wo contrast, CT Abdomen and Pelvis wo+w contrast CLINICAL INFORMATION: 49-year-old female with evaluation for septic shock, lactic acidosis, and respiratory failure. History of lymphoma. Patient is on pressors. COMPARISON: CT chest dated 12/1/2021. PET/CT dated 10/21/2021. TECHNIQUE: CT Chest wo contrast, CT Abdomen and Pelvis wo+w contrast. Scan field of view: 350 mm. DLP: 475 mGy cm. (accession CT220003369), Patient weight: 254 lbs. IV contrast: Omnipaque 350, 150 ml, per protocol. Saline flush: 75 ml. IV contrast injection rate: 4 ml per sec. Scan delay: bolus tracked Scan field of view: 450 mm. DLP: 3166 mGy cm. (accession CT220003332) FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Secretions are seen in the trachea. Endotracheal tube tip seen approximately 3.8 centimeters above the carina. Upper lobe and interlobular septal thickening. Consolidations with air bronchograms in the dependent portions of the lower lobes are new. Small effusions. HEART / VESSELS: Left chest port catheter tip in right IJ central venous catheter tip are seen in the right atrium. Enlarged main pulmonary artery measures 4.1 cm compared to 3.0 cm on prior. MEDIASTINUM / ESOPHAGUS: Focus of gas is again seen in the mediastinum and along the right trachea. Esophogastric tube in place with the tip in the stomach body. LYMPH NODES: Interval decrease in size of the enlarged right axillary lymph node measuring 2.9 x 2.0 cm (series 3, image 59) compared to 3.6 x 2.6 cm on prior. Other enlarged right axillary lymph nodes are seen and are similar to slightly increased in size compared to prior exam. For example right adnexa measures 1.8 cm in short axis (series 3, image 32) compared to 1.5 cm on prior exam (series 2, image 36). CHEST WALL: VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No aneurysm, dissection, or significant stenosis. ABDOMINAL AORTA: No aneurysm, dissection, or significant stenosis. CELIAC AXIS: No aneurysm, dissection, or significant stenosis. Replaced right hepatic artery off the SMA. SMA: No aneurysm, dissection, or significant stenosis. RIGHT RENAL: No aneurysm, dissection, or significant stenosis. LEFT RENAL: No aneurysm, dissection, or significant stenosis. IMA: No aneurysm, dissection, or significant stenosis. RIGHT ILIAC AND FEMORAL ARTERIES: No aneurysm, dissection, or significant stenosis. LEFT ILIAC AND FEMORAL ARTERIES: No aneurysm, dissection, or significant stenosis. ABDOMEN and PELVIS: LIVER: Similar renal cysts. Other subcentimeter hypoattenuating lesions are too small characterize. Periportal edema. BILIARY TRACT: Normal. GALLBLADDER: Wall thickening and surrounding edema/stranding. PANCREAS: Peripancreatic stranding along the pancreatic head and uncinate process. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right renal cysts. No hydronephrosis or suspicious lesion. Nonspecific perinephric stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is normal. A short segment of small bowel in the left pelvis demonstrates wall thickening with inflammatory stranding (series 10, image 276). COLON / APPENDIX: Wall thickening of the ascending hepatic flexure with surrounding inflammatory changes. The hepatic flexure appears to be hypoenhancing to the remaining bowel. No pneumatosis intestinalis. PERITONEUM / MESENTERY: Small volume ascites. No free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Collapsed with Foley catheter in place. Wall thickening. Intraluminal gas likely secondary to catheterization. REPRODUCTIVE ORGANS: Status post hysterectomy. No suspicious adnexal lesion. BODY WALL: Subcutaneous gas of the anterior abdominal wall likely secondary to post injection changes. Mild anasarca. MUSCULOSKELETAL: Mild spondylosis of the visualized spine without destructive osseous lesion. CONCLUSION: 1. Wall thickening and inflammatory changes of the hepatic flexure watershed region and short segment of small bowel are suspicious for ischemic bowel. Recommend correlation with lactic acid acid levels and surgical consultation. 2. New consolidations in the lower lobes may represent aspiration, infection, or atelectasis. 3. Cardiomegaly with pulmonary edema small effusions concerning for heart failure. 4. Pathologically enlarged axillary lymph nodes are again seen, some increased in size and others decreased and compatible with diagnosis of lymphoma. 5. Wall thickening and plantar changes of the gallbladder may be reactive versus cholecystitis. 6. Inflammatory changes along the pancreatic head and uncinate process may be reactive versus pancreatitis. Ancillary findings above. The findings were discussed with Dr. Chad Lynch by Dr. Jason Davis via telephone on 1/6/2022 11:01 PM. As the attending physician, I have personally reviewed the images, interpreted and/or supervised the study or procedure, and agree with the wording of the above report.
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FINDINGS: CT imaging was performed without IV contrast, which can reduce diagnostic accuracy. STRUCTURED REPORT: CT CAP LOWER NECK: Normal. CHEST: LUNGS / AIRWAYS / PLEURA: Secretions are seen in the trachea. Endotracheal tube tip seen approximately 3.8 centimeters above the carina. Upper lobe and interlobular septal thickening. Consolidations with air bronchograms in the dependent portions of the lower lobes are new. Small effusions. HEART / VESSELS: Left chest port catheter tip in right IJ central venous catheter tip are seen in the right atrium. Enlarged main pulmonary artery measures 4.1 cm compared to 3.0 cm on prior. MEDIASTINUM / ESOPHAGUS: Focus of gas is again seen in the mediastinum and along the right trachea. Esophogastric tube in place with the tip in the stomach body. LYMPH NODES: Interval decrease in size of the enlarged right axillary lymph node measuring 2.9 x 2.0 cm (series 3, image 59) compared to 3.6 x 2.6 cm on prior. Other enlarged right axillary lymph nodes are seen and are similar to slightly increased in size compared to prior exam. For example right adnexa measures 1.8 cm in short axis (series 3, image 32) compared to 1.5 cm on prior exam (series 2, image 36). CHEST WALL: VASCULATURE: DISTAL DESCENDING THORACIC AORTA: No aneurysm, dissection, or significant stenosis. ABDOMINAL AORTA: No aneurysm, dissection, or significant stenosis. CELIAC AXIS: No aneurysm, dissection, or significant stenosis. Replaced right hepatic artery off the SMA. SMA: No aneurysm, dissection, or significant stenosis. RIGHT RENAL: No aneurysm, dissection, or significant stenosis. LEFT RENAL: No aneurysm, dissection, or significant stenosis. IMA: No aneurysm, dissection, or significant stenosis. RIGHT ILIAC AND FEMORAL ARTERIES: No aneurysm, dissection, or significant stenosis. LEFT ILIAC AND FEMORAL ARTERIES: No aneurysm, dissection, or significant stenosis. ABDOMEN and PELVIS: LIVER: Similar renal cysts. Other subcentimeter hypoattenuating lesions are too small characterize. Periportal edema. BILIARY TRACT: Normal. GALLBLADDER: Wall thickening and surrounding edema/stranding. PANCREAS: Peripancreatic stranding along the pancreatic head and uncinate process. SPLEEN: Normal. ADRENALS: Normal. KIDNEYS: Right renal cysts. No hydronephrosis or suspicious lesion. Nonspecific perinephric stranding. LYMPH NODES: None enlarged. STOMACH / SMALL BOWEL: Stomach is normal. A short segment of small bowel in the left pelvis demonstrates wall thickening with inflammatory stranding (series 10, image 276). COLON / APPENDIX: Wall thickening of the ascending hepatic flexure with surrounding inflammatory changes. The hepatic flexure appears to be hypoenhancing to the remaining bowel. No pneumatosis intestinalis. PERITONEUM / MESENTERY: Small volume ascites. No free air. RETROPERITONEUM: Normal. VESSELS: No significant abnormality. URINARY BLADDER: Collapsed with Foley catheter in place. Wall thickening. Intraluminal gas likely secondary to catheterization. REPRODUCTIVE ORGANS: Status post hysterectomy. No suspicious adnexal lesion. BODY WALL: Subcutaneous gas of the anterior abdominal wall likely secondary to post injection changes. Mild anasarca. MUSCULOSKELETAL: Mild spondylosis of the visualized spine without destructive osseous lesion.
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FINDINGS: BRAIN PARENCHYMA: No acute intracranial hemorrhage, midline shift, or edema. Noncalcified, dural based lesion adjacent to the right frontal lobe measuring 9.3 x 8.4 mm (image 48, series 201). There is associated remodeling of the inner table of the skull. Gray-white matter differentiation is maintained. Mild diffuse parenchymal volume loss. EXTRA-AXIAL SPACES: Normal. VENTRICULAR SYSTEM: Mild ex vacuo ventriculomegaly. ORBITS: Fracture of the right lamina papyracea with herniation of fat. The extraocular muscles are normal. Bilateral lens replacements. SKULL AND SKULL BASE: No skull base fracture is detected. Fat-containing lesion in the sphenoid likely represents intraosseous lipoma. FACIAL BONES: No definite acute fracture. MANDIBLE: Normal. Temporomandibular joints are normally aligned. Scattered dental caries. Torus palatini. SINONASAL CAVITIES: Opacification of the right maxillary sinus with hyperdense inspissated contents and mild osteitis. Mildly displaced, comminuted type II fracture of the dens.
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